Toxic effects of dietary copper and EGCG on bioaccumulation, antioxidant enzyme and immune response of Korean bullhead, Pseudobagrus fulvidraco.

There are few reports of dietary Cu (copper) toxicity to Korean bullhead, Pseudobagrus fulvidraco, and little is known about recovery from dietary Cu exposure. In this study, P. fulvidraco (mean length 16.9 ± 1.38 cm, and mean weight 53.2 ± 1.22 g) were exposed for 4 weeks to dietary Cu concentration of 0 (control), 700, 900, and 1100 mg Cu kg-1 dry feed to establish maximum tolerable levels of dietary Cu. All fish were then fed the dietary EGCG (Epigallocatechin gallate) concentration of 100 and 500 mg EGCG kg-1 dry feed for a further 2 weeks to assess recovery. We were measured bioaccumulation (in the intestine, liver, and gill tissue), antioxidant enzymes (SOD and CAT) and immune responses (lysozyme and phagocytosis). The Cu exposure induced a significant accumulation in the intestine, liver, and gill tissues and the highest accumulation was observed in intestinal tissues (17-34 fold), but dietary EGCG exposure decreased (about 0.8-fold) Cu concentration in each tissue (ANOVA, P < 0.05). In antioxidant enzymes, SOD and CAT significantly increased by approximately 1.6-fold by dietary Cu exposure in the liver and gill tissue, respectively, but dietary EGCG exposure decreased SOD and CAT by about 1.1-fold, respectively (ANOVA, P < 0.05). For immune responses, lysozyme and phagocytosis in the blood significantly were decreased by approximately 1.5-fold, respectively, by dietary Cu exposure, but dietary EGCG exposure increased lysozyme and phagocytosis by about 1.1-fold, respectively (ANOVA, P < 0.05). During recovery period, bioaccumulation, antioxidant enzymes (SOD and CAT activity), and immune response (lysozyme and phagocytosis activity) tended to alleviate the significant changes by Cu exposure, and the tendency to return normal state was observed in high level of EGCG. The result of this study indicate that Cu exposure to P. fulvidraco affects bioaccumulation, antioxidant enzymes, and immune responses, and high level of EGCG were effective to alleviate the toxic effects of Cu exposure.

Preparation and characterization of TiO2 generated from synthetic wastewater using TiCl4 based coagulation/flocculation aided with Ca(OH)2.

This study focused on the preparation of undoped and Ca-doped titania from flocculation generated sludge. Initially, TiCl4 was utilised to perform coagulation and flocculation in synthetic wastewater and an optimised dose of coagulant was determined by evaluating the turbidity, dissolved organic carbon (DOC) and zeta potential of the treated water. Later, using Ca(OH)2 as a coagulant aid, the effects on effluent pH, turbidity and DOC removal were investigated. Both Ca-doped and undoped anatase TiO2 were prepared from the flocculated sludge for morphological and photocatalytic evaluation. During the standalone use of TiCl4, maximum turbidity and DOC removal were found at 11.63 and 14.54 mg Ti/L, respectively. At the corresponding coagulant dose, rapid deprotonation of water caused the pH of the effluent to reach below 3.77 mg Ti/L. Whereas, when using Ca(OH)2 as a coagulant aid, a neutral pH (7.26) was attained at a simultaneous dosing of 32.40 mg Ca/L and 14.54 mg Ti/L. When aided with Ca(OH)2, the turbidity removal was further increased by 54.28% and the DOC removal was somewhat similar to the standalone use of TiCl4. TiO2 was prepared by incinerating the collected sludge at 600 °C for 2 h. Both XRD and SEM analysis were conducted to observe the morphology of the prepared titania. The XRD pattern of the TiO2 showed only an anatase phase along with the presence of a high atomic proportion of Ca (4.14%). Consequently, a high amount of Ca atoms inhibited the level of TiO2 phase and no obvious presence of CaO was observed. The prepared Ca-doped TiO2 at the optimised dose of Ca(OH)2 was found to be inferior to the undoped TiO2 during the photodegradation of acetaldehyde. However, a reduced dose of Ca(OH)2 (<15 mg Ca/L) exhibited a substantial increase in photoactivity under UV irradiance.

Changes in Hematological Parameters and Heat Shock Proteins in Juvenile Sablefish Depending on Water Temperature Stress.

Juvenile Sablefish Anoplopoma fimbria were used to assess the effects of water temperature (8, 10, 12, 14, 16, 18, and 20°C) on hematological parameters and heat shock proteins 70 and 90 for 4 months. Hematological parameters, including red blood cell count, hematocrit, and hemoglobin, were significantly decreased at 18°C. The inorganic plasma components calcium and magnesium were not altered by water temperature. The organic plasma components glucose and cholesterol were notably elevated at 18°C, whereas total protein was reduced. The enzymatic components, including aspartate aminotransferase, alanine aminotransaminase, and alkaline phosphatase, were notably elevated at 16°C or 18°C. The results of this study indicate that a temperature higher than the proper temperature affects the hematological parameters and heat shock proteins of juvenile Sablefish.

Toxic Effects and Depuration on the Antioxidant and Neurotransmitter Responses after Dietary Lead Exposure in Starry Flounder.

Starry Flounder Platichthys stellatus were exposed to dietary lead (Pb) at concentrations of 0, 30, 60, 120, and 240 mg/kg for 4 weeks. Recover period was conducted for 2 weeks after the exposure. Exposure to Pb concentrations over 60 mg/kg induced significant changes in the antioxidant responses in the liver, kidney, and gill and continued even after the depuration period in the liver (over 120 mg/kg for superoxide dismutase [SOD] activity) and kidney (at 240 mg/kg for glutathione [GSH] levels). Glutathione S-transferase (GST) activity in liver, kidney, and gill were increased by dietary Pb exposure, and recovery was observed in all groups during the recovery period. Acetylcholinesterase (AChE) activity was significantly inhibited in the brain and muscle of flounder at Pb exposure over 120 mg/kg, and no restoration was observed after the depuration period. Lysozyme activity in the plasma was significantly increased at Pb exposures greater than 60 mg kg but was restored after the depuration period. The results of this study indicate that dietary Pb exposure induces toxic effects on antioxidant responses, neurotransmitter, and immune responses of Starry Flounder.

Growth performance, oxidative stress, and non-specific immune responses in juvenile sablefish, Anoplopoma fimbria, by changes of water temperature and salinity.

Juvenile sablefish, Anoplopoma fimbria (mean length 15.5 ± 1.9 cm, mean weight 68.5 ± 4.8 g), were used to evaluate the effects on growth, oxidative stress, and non-specific immune responses by changes of water temperature (8, 10, 12, 14, 16, 18, and 20 °C) and salinity (100 (35.0), 90 (31.5), 80 (28.0), 70 (24.5), 60 (21.0), 50 (17.5), and 40% (14.0) (‰)) for 4 months. The growth performance was significantly increased at the temperature of 12 and 14 °C, and the feed efficiency was notably decreased at the temperature of 18 °C. The growth performance and feed efficiency were also significantly decreased at low salinity. The antioxidant responses such as superoxide dismutase and catalase were significantly increased by the high temperature and decreased by the low salinity. The immune responses such as lysozyme and phagocytosis were elevated by the temperature of 18 °C and decreased by the salinity of 50%. The results of this study indicate that the growth performance of juvenile sablefish, A. fimbria, is influenced by the temperature and salinity, and the excessive temperature and salinity levels can affect the antioxidant and immune responses.

Glycoepitopes of staphylococcal wall teichoic acid govern complement-mediated opsonophagocytosis via human serum antibody and mannose-binding lectin.

Serum antibodies and mannose-binding lectin (MBL) are important host defense factors for host adaptive and innate immunity, respectively. Antibodies and MBL also initiate the classical and lectin complement pathways, respectively, leading to opsonophagocytosis. We have shown previously that Staphylococcus aureus wall teichoic acid (WTA), a cell wall glycopolymer consisting of ribitol phosphate substituted with α- or ß-O-N-acetyl-d-glucosamine (GlcNAc) and d-alanine, is recognized by MBL and serum anti-WTA IgG. However, the exact antigenic determinants to which anti-WTA antibodies or MBL bind have not been determined. To answer this question, several S. aureus mutants, such as α-GlcNAc glycosyltransferase-deficient S. aureus ΔtarM, ß-GlcNAc glycosyltransferase-deficient ΔtarS, and ΔtarMS double mutant cells, were prepared from a laboratory and a community-associated methicillin-resistant S. aureus strain. Here, we describe the unexpected finding that ß-GlcNAc WTA-deficient ΔtarS mutant cells (which have intact α-GlcNAc) escape from anti-WTA antibody-mediated opsonophagocytosis, whereas α-GlcNAc WTA-deficient ΔtarM mutant cells (which have intact ß-GlcNAc) are efficiently engulfed by human leukocytes via anti-WTA IgG. Likewise, MBL binding in S. aureus cells was lost in the ΔtarMS double mutant but not in either single mutant. When we determined the serum concentrations of the anti-α- or anti-ß-GlcNAc-specific WTA IgGs, anti-ß-GlcNAc WTA-IgG was dominant in pooled human IgG fractions and in the intact sera of healthy adults and infants. These data demonstrate the importance of the WTA sugar conformation for human innate and adaptive immunity against S. aureus infection.

In vitro and in vivo evaluation of the genotoxicity of titanium dioxide, GST.

Titanium dioxide (TiO2) was used in various applications in a wide range of products including food, cosmetics and photocatalyst. General toxicity studies of titanium dioxide, GST (Green Sludge Titanium) have been investigated in several reports, whereas studies concerning mutagenicity and genotoxicity have not been elucidated. Herein, we investigated the potential mutagenicity and genotoxicity of GST by genetic toxicology testing. The bacterial reverse mutation test was conducted by the pre-incubation method in the presence and absence of metabolic activation system (S9 mixture). The chromosome aberration test was performed using cultured Chinese hamster lung cell line in the absence and presence of S9 mixture. The micronucleus test was performed by using specific pathogen-free male ICR mice. Genotoxicity tests were conducted following the test guidelines of the Organisation for Economic Cooperation and Development with application of Good Laboratory Practice. No statistically significant increases were found in the bacterial reverse mutation test, in vitro chromosome aberration test, and in vivo micronucleus test when tested for induction of genotoxicity in GST. These results suggest that GST did not induce mutagenicity and genotoxicity in both in vitro and in vivo system.

Prevalence of primary immunodeficiency in Korea.

This study represents the first epidemiological study based on the national registry of primary immunodeficiencies (PID) in Korea. Patient data were collected from 23 major hospitals. A total of 152 patients with PID (under 19 yr of age), who were observed from 2001 to 2005, have been entered in this registry. The period prevalence of PID in Korea in 2005 is 11.25 per million children. The following frequencies were found: antibody deficiencies, 53.3% (n = 81), phagocytic disorders, 28.9% (n = 44); combined immunodeficiencies, 13.2% (n = 20); and T cell deficiencies, 4.6% (n = 7). Congenital agammaglobulinemia (n = 21) and selective IgA deficiency (n = 21) were the most frequently reported antibody deficiency. Other reported deficiencies were common variable immunodeficiencies (n = 16), X-linked agammaglobulinemia (n = 15), IgG subclass deficiency (n = 4). Phagocytic disorder was mostly chronic granulomatous disease. A small number of patients with Wiskott-Aldrich syndrome, hyper-IgE syndrome, and severe combined immunodeficiency were also registered. Overall, the most common first manifestation was pneumonia. This study provides data that permit a more accurate estimation PID patients in Korea.

Reproductive and developmental toxicity screening test of new TiO2 GST in Sprague-Dawley rats.

TiO2 nanoparticles are widely used in paints, plastics, cosmetics, printing ink, rubber, food products, pharmaceuticals and other products (photocatalyst, etc.). However, there is little toxicological information during reproduction and developmental period. This study was performed to obtain safety data for new TiO2 powder, GST (Green Sludge Titanium) produced through sludge recycling of the sewage treatment plant for Reproduction/developmental toxicity screening test in Sprague-Dawley (SD) rats in according to the OECD test guideline (TG 421). Based on the results of the dose-range finding study (14-day repeated toxicity), GST was orally administered to rats at doses of 0, 500, 1000, and 2000 mg/kg B.W/day. Males were dosed for 35 days beginning 14 days before mating, and females for a maximum of 53 days beginning 14 days before mating to day 13 of lactation, including throughout the mating, gestation and lactation periods. In the reproductive and developmental examinations, there were no marked toxicities in terms of general clinical signs, body weight, food consumption, organ weights, macroscopic / microscopic findings, stages of spermatogenesis in the testis, reproductive finding (estrous cycle, copulation-fertility-gestation index), developmental finding (number of corpora lutea and implantations, pups parameters including live birth and viability index). The NOAEL for reproductive/developmental screening toxicity was concluded to be 2000 mg/kg/day under the present study conditions.

Repeated-dose 28-day dermal toxicity study of TiO2 catalyst (GST) in Sprague-Dawley rats.

TiO2 have been studied on inhalation and skin exposure due to the properties of the materials' use (cosmetics, paints and other products) and the additional safety information on other intake routes for the potential risk assessment is limited. The aim of this study was to obtain dose-range for subchronic study (repeated 90-day dermal toxicity) new TiO2 powder, GST produced through sludge recycling of the sewage treatment plant through repeated-dose toxicity in Sprague-Dawley (SD) rats. Three test groups for the GST were administered at 500, 1000, 2000 mg/kg B.W/day in addition to a control group (distilled water for injection). 5 male and 5 female rats were included in each group, and we examined the clinical signs, body weights, food consumption, necropsy (organ weights, macroscopic findings), hematological / biochemical parameters and histopathological findings (eye, skin). As a result of observations, there were no treatment-related effects including clinical signs, mortality, necropsy findings etc. Therefore, the present results suggest that the TiO2-related effects were not observed for dermal during 28-day and dose selection for repeated 90-day study was considered to be 500, 1000 and 2000 mg/kg B.W/day under the present study conditions.

Repeated-dose 90-day oral toxicity study of GST in Sprague-Dawley rats.

TiO2 have been studied on inhalation and skin exposure due to the properties of the materials' use (cosmetics, paints and other products) and the additional safety information on other intake routes for the potential risk assessment is limited. Therefore, the aim of this study was to obtain safety data for new TiO2 powder, GST produced through sludge recycling of the sewage treatment plant through repeated-dose toxicity in Sprague-Dawley (SD) rats in according to the OECD test guideline (TG 408). Based on the results of the dose-range finding study (28-day repeated toxicity), GST was orally administered to rats at doses of 0, 500, 1000, and 2000 mg/kg B.W/day for 90-day and reversibility of effects of 2000 mg/kg bw/day was assessed after 4 weeks. In clinical signs, compound-colored stool was observed in all animals of treatment group (low: day 14 or 15, middle: day 8, high: day 8) and continuously observed up to the end of administration or day 1 of recovery period (high dose group). Also, the test substance retention in gastro-intestinal tract was observed in all animals of treatment group in gross finding at necropsy and foreign materials in lumen of these organs (stomach, duodenum, ileum, cecum, colon, rectum) likely indicative for the presence of test material in histopathological examination. In addition, no test substance-related adverse effects were noted in the detailed clinical observations, sensory reactivity/ functional assessments, body weight, food consumption, urinary analysis, ophthalmological examination, hematological / biochemical parameters, organ weights, histopathological findings. Therefore, the present results show that the NOAEL (no observed adverse effect level) of new TiO2 powder, GST was considered to be 2000 mg/kg B.W/day in rats after repeated oral administration for 90-day under the present study conditions and no target organs were identified.

Acute toxicity assessment for TiO2 photocatalyst (GST) made from wastewater using TiCl4 in rat.

TiO2 was a photocatalyst that used to the most common product because of the high efficiency. TiO2 (P-25, commercial nanomaterial product) is the most typical photocatalyst product and TiO2 (GST) was a sludge recycling product. This study was reported to evaluate an acute toxicity of TiO2 (P-25 and GST) according to OECD test guideline 402 and 423 in Sprague-Dawley (SD) female rats via route of oral and dermal. There was investigated the lethal dose (LD50), and mortality, clinical signs, body weight changes and gross findings were continually monitored for 14 days following the single administration. After administration, TiO2 (P-25) was calculated that LD50 was considered to be a dose of over 2000 mg/kg body weight for both different route of exposure, and TiO2 (GST) was the same. Other items were no observed an adverse effect between P-25 and GST; no mortality and clinical signs, accidental body weight loss, no gross findings. On the basis of the above results, the toxicity of the GST was almost equal to that of the commercial product, P-25 and there was no toxicological evidence.

In vitro acute inhalation toxicity for TiO2 (GST) using 3D human tissue model (EpiAirwayTM).

The present study was performed to screen in vitro potential acute inhalation toxicity using an EpiAirwayTM tissue model (human tracheal/bronchial tissue) for the nano-sized titanium dioxide, GST manufactured as a photocatalyst through of sludge recycling and to compare with P-25 a commercialized photocatalytic material. According to the protocol provided by in vitro tissue manufacturer, the GST was exposure to the tissue for 3 hours in 450, 500, 650, 850 mg/mL concentration after preliminary dose range finding study and then tissue viability (%, IC75) was calculated using the MTT assay. Besides, the histopathological observation was performed to compare to the MTT assay. As a result of study, IC75 could not be confirmed at 850 mg/mL in both GST and P-25 and the grade was confirmed to be IC75> 600 mg/mL in vitro model tissue category. Therefore, it was considered that the GHS category could be classified as 'No classification' in screening method for potential acute inhalation toxicity. Also, not the morphological effects of epithelial cells in tissue model were observed compared with the vehicle control and histological findings were similar to the results of MTT Viability assay. Based on these results, the potential acute inhalation toxicity for GST produced through sludge recycling using in vitro tissue model inhalation toxicity showed that it could be non-hazardous substance. However, further study (in vivo study, etc.) is thought to be needed to ascertain whether GST is a toxic effect or safe.

Evaluation of potential eye or skin irritation/corrosion in rabbit exposed to TiO2 photocatalyst (GST).

TiO2 NPs photocatalyst is widely used in a variety of applications and products in the environmental and energy fields, including self-cleaning surfaces, air and water purification systems, sterilization, hydrogen evolution, and photoelectrochemical conversion. The possible biological and safety effects of TiO2 dermal exposure and absorption have not been well studied and more investigations on the potential health hazards of the TiO2 are needed. This study aimed to investigate potential effect of local lesions (eye and skin irritation/corrosion) for new TiO2 material powder, GST produced through sludge recycling of the sewage treatment plant in according to the OECD test guideline (TG 404, 405) and imaging evaluation (micro-computed tomography analysis), histopathology examination. Also, P-25, commercial photocatalyst was used to compare with GST. For the eye or skin irritation/corrosion test, the test substances (GST, P-25) showed no irritation/corrosion for local lesions and the GHS category was identified as a "No hazard class". The imaging analysis indicated that GST did not penetrate or distribute in the local lesions (eye, skin) and the treatment-related effect was not observed in histopathology. Therefore, the present study revealed that new TiO2 powder, GST was considered to be no potential effects (irritation/corrosion), penetration or distribution in the local lesions (eye, skin).

Resveratrol reduces glutamate-mediated monocyte chemotactic protein-1 expression via inhibition of extracellular signal-regulated kinase 1/2 pathway in rat hippocampal slice cultures.

Published evidence has linked glutamate with the pathogenesis of Alzheimer's disease (AD) and the up-regulation of a variety of chemokines, including monocyte chemotactic protein-1 (MCP-1)/chemokine ligand 2, with AD-associated pathological changes. In this study, we assessed the potential molecular basis for the role of glutamate in hippocampal inflammation by determining its effects on MCP-1 induction. We also attempted to identify the mechanism by which resveratrol (trans-3,5,4'-trihydroxystilbene), a polyphenolic phytostilbene, modulates the expression of MCP-1 in the glutamate-stimulated hippocampus. An ex vivo study using rat hippocampal slices demonstrated a time- and dose-dependent increase in MCP-1 release from glutamate-exposed hippocampus. This increase was accompanied by enhanced MCP-1 gene expression via the activation of the MEK/extracellular signal-regulated kinase (ERK) pathway and interleukin-1beta (IL-1beta) expression. The inhibition of the MEK/ERK pathway with SL327, which is capable of crossing the blood-brain barrier, nearly abolished the observed glutamate-induced effects. Furthermore, anti-IL-1beta antibodies suppressed the glutamate-induced expression of MCP-1 mRNA and protein, whereas an isotype-matched antibody exerted only minimal effects. It is worthy of note that resveratrol, to a similar degree as SL327, down-regulated glutamate-induced IL-1beta expression and reduced the expression of MCP-1 mRNA and protein release via the inactivation of ERK1/2. These results indicate that the activation of the MEK/ERK pathway and the consequent IL-1beta expression are essential for glutamate-stimulated MCP-1 production in the hippocampus. Additionally, our data reveal an anti-inflammatory mechanism of resveratrol involving the inactivation of the ERK1/2 pathway in the hippocampus, which is linked principally to AD-associated cognitive dysfunction.

Preparation of TiO2 nanoparticle from Ti-salt flocculated sludge with dye wastewater.

Dye wastewater flocculation using TiCl4 and FeSO4 coagulants was studied for organic removal and precipitation efficiency. Moreover, TiCl4 was assessed in a pilot-scale flocculation process to investigate organic removal and solution pH effect. A large amount of TiO2 was produced from sludge of Ti-salt flocculation in dye wastewater. This flocculation process simultaneously reduces a large amount of sludge produced from wastewater. The TiO2 nanoparticle was characterized in terms of physical and chemical properties. Results showed that 77.6% of organic matter was removed from dye wastewater when using FeSO4 as coagulant, while TiCl4 degraded 75.9% of organic matter. On the other hand, floc precipitation efficiency was better for TiCl4 if compared with FeSO4. The optimum concentration of TiCl4 for pilot-scale flocculation was found to be equal to 2.1 g/L. DWT (Dye wastewater titania) size was 15-20 nm, mainly doped with carbon atoms and exhibited a dominant anatase structure. DWT was similar to P-25 in decomposing acetaldehyde under UV-irradiation and complete photocatalytic degradation was achieved after 140 min.

TLR-4 agonistic lipopolysaccharide upregulates interleukin-8 at the transcriptional and post-translational level in vascular smooth muscle cells.

Despite extensive studies on cellular responses to activation of Toll-like receptor-4 (TLR-4), it is not evident weather its activation affects gene expression of interleukin-8 (IL-8) in vascular smooth muscle cells (VSMCs). Therefore, this study has investigated whether and how TLR-4 influences IL-8 expression in VSMCs. Exposure of aortic smooth muscle cells to TLR-4 agonistic lipopolysaccharide (LPS) not only enhanced release of IL-8 protein but also induced IL-8 gene transcript via promoter activation. The LPS-induced activation of IL-8 promoter was attenuated by dominant-negative MKK1, but not by dominant-negative MKK3. The promoter activation was also impaired by dominant negative CCAAT/enhancer binding protein (C/EBP), IkappaB, and dominant negative c-Jun. In comparison with the mutation of the AP-1 binding site, the mutation of NF-kappaB site and C/EBP binding site in the IL-8 promoter region more significantly impaired the promoter activation. Moreover, both promoter activity and release of IL-8 were inhibited by U0126 and curcumin, but not by SB202190, epigallocatechin 3-gallate and resveratrol. The present study reports that TLR-4-agonistic LPS upregulates IL-8 at the transcriptional and post-translational level in VSMCs, and that ERK1/2, NF-kappaB, and C/EBP play major roles in the upregulation of IL-8.

Comparative study of the effects of different growth hormone doses on growth and spatial performance of hypophysectomized rats.

This study was designed to examine the effects of recombinant human growth hormone replacement on somatic growth and cognitive function in hypophysectomized (HYPOX) female Sprague-Dawley rats. Rats (5 per group) were randomized by weight to 3 experimental groups: group 1, administered 200 microg/kg of GH once daily for 9 days; group 2, administered 200 microg/kg of GH twice daily; and group 3, administered saline daily. Somatic growth was evaluated by measurement of body weight daily and of the width of the proximal tibial growth plate of the HYPOX rats. Cognitive function was evaluated using the Morris water maze (MWM) test. The results indicated that GH replacement therapy in HYPOX rats promoted an increase in the body weight and the width of the tibial growth plate in a dose-dependent manner. On the third day of the MWM test, the escape latency in the GH-treated groups 1 and 2 was significantly shorter than that in the control rats (P<0.001 and P=0.032, respectively), suggesting that rhGH improved spatial memory acquisition in the MWM test. Therefore it is concluded that rhGH replacement therapy in HYPOX rats stimulates an increase in somatic growth in a dose-dependent manner and also has beneficial effects on cognitive functions.

Multicenter Adherence Study of Asthma Medication for Children in Korea.

PURPOSE: Adherence is a major component of successful medical treatment. However, non-adherence remains a barrier to effective delivery of healthcare worldwide. METHODS: Twenty healthcare facilities (secondary or tertiary hospitals) belonging to the Korean Academy of Pediatric Allergy and Respiratory Diseases (KAPARD) participated. Questionnaires were given to patients currently receiving treatment in the form of inhalant useor oral intake or transdermal patch for mild to moderate asthma. RESULTS: A total of 1,838 patients responded to the questionnaire. Mean age was 5.98 ± 3.79 years (range: 0-18 years). With help from their caregivers, the percentage of patients that answered "taking as prescribed" was 38.04% for inhalant users, 50.09% for oral medication users and 67.42% for transdermal users. Transdermal patch users had significantly greater adherence compared to the other 2 groups (P < 0.001). The 34.15% of inhalant users, 70.33% of oral medication users and 93.00% of transdermal patch users felt that their medication delivery system was "Easy" or "Very easy" to use (P < 0.001). "Method of administration" was deemed to be the most difficult part of the treatment regimen to follow, and 76.7% of patients preferred once-daily administration (i.e., "Frequency of administration"). CONCLUSIONS: Asthma medication adherence in young children was found to be better in the transdermal patch group. This may be due to requiring fewer doses and easy to follow instructions. From an adherence point of view, the transdermal patch seems more useful for long-term asthma control in children compared to oral or inhaled medicine.

Disseminated BCG pneumonitis revealing severe combined immunodeficiencyxs in CHARGE syndrome.

CHARGE (coloboma, heart defect, atresia choanae, retarded growth and development, genital hypoplasia, and ear anomalies/deafness) syndrome is a rare genetic disorder caused by CHD7 mutation and is related to immunodeficiency. A 6-month-old girl with right lung agenesis, congenital heart defects, and ear anomalies developed repeated and serious respiratory infection for a short period. She was clinically diagnosed with typical CHARGE syndrome with severe combined immunodeficiency (T-, B+, NK-); however, CHD7 mutation was not detected. Disseminated BCG infection did not resolve despite administration of anti-tuberculosis drugs and intravenous immune globulins, and she subsequently died of acute respiratory distress syndrome. Pediatr Pulmonol. 2017;52:E4-E6. © 2016 Wiley Periodicals, Inc.