Brain–Gut–Microbiota Axis / 대한소화기학회지

Patients frequently report that stress causes or exacerbates gastrointestinal (GI) symptoms, indicating a functional relationship between the brain and the GI tract. The brain and GI tract are closely related embryologically and functionally, interacting in various ways. The concept of the brain–gut axis was originally established in the 19th and early 20th centuries based on physiological observations and experiments conducted in animals and humans. In recent years, with the growing recognition that gut microbiota plays a vital role in human health and disease, this concept has been expanded to the brain–gut–microbiota axis. The brain influences the motility, secretion, and immunity of the GI tract, with consequent effects on the composition and function of the gut microbiota. On the other hand, gut microbiota plays an essential role in the development and function of the brain and enteric nervous system. Although knowledge of the mechanisms through which the gut microbiota influences distant brain function is incomplete, studies have demonstrated communication between these organs through the neuronal, immune, and endocrine systems. The brain–gut–microbiota axis is an essential aspect of the pathophysiology of functional GI disorders such as irritable bowel syndrome, and is also involved in other GI diseases, including inflammatory bowel disease. This review summarizes the evolving concept of the brain–gut–microbiota axis and its implications for GI diseases, providing clinicians with new knowledge to apply in clinical practice.

Analysis of 2011-2020 intentional drug poisoning in children and adolescents

Purpose@#We aimed to investigate the changing trends in intentional drug poisoning among pediatric and adolescent patients over the past 10 years. @*Methods@#A retrospective study was conducted on patients younger than 20 years who visited an academic hospital emergency department (ED) in Incheon, Korea, from January 2011 through December 2020. The study focused on patients who responded with “self-harm or suicide” in the ED-based Injury In-depth Surveillance, and whose injury mechanism was drug poisoning. Exclusion criteria were unintentional injuries and the ingestion of substances other than drugs. To describe the trend over the decade, we used the number of events/100,000 ED annual visits of the database. @*Results@#A total of 3,388 cases with a median age of 17 years (interquartile range, 15-18 years) were included. The most frequently ingested drugs were acetaminophen (27.8%), followed by benzodiazepines (15.2%), antidepressants (14.1%), other sedatives and hypnotics (13.4%), and antipsychotics (8.3%). As for the events/100,000 ED annual visits, benzodiazepines showed the biggest increase, from 7.6 to 80.2 cases. Similarly, antidepressants increased from 10.2 to 71.1 cases, and antipsychotics from 3.6 to 53.7 cases. @*Conclusion@#Intentional drug poisoning has increased over the past 10 years, particularly in benzodiazepines, antidepressants, and antipsychotics. It is advisable to establish injury prevention strategies according to patients’ characteristics and ingested drugs.

Clinical Features and Risk Factors of Post-COVID-19 Condition in Korea / 예방의학회지

Objectives@#Numerous studies have explored the causes and spread of outbreaks, yet there is a lack of research on post-coronavirus disease 2019 condition (PCC) in Korea. The goal of this study was to identify the various types of PCC and associated factors in discharged patients and to provide directions for the ongoing health management of confirmed patients. @*Methods@#A telephone survey was conducted among 680 coronavirus disease 2019 (COVID-19) patients diagnosed between July 7, 2021 and August 26, 2021, in Dangjin, Chungnam, Korea. A descriptive analysis of characteristics, univariate analysis, and regression were performed using data from basic epidemiological surveys conducted at the time of diagnosis and post-discharge questionnaires. @*Results@#Of the 585 patients who responded, 159 (27.2%) developed PCC. Of the 211 patients with no initial symptoms, 27 (12.8%) developed PCC, versus 132 (35.3%) of the 374 patients with initial symptoms. Among the initial symptoms, fever or chills, cough or sputum, loss of smell, and sore throat were associated with PCC. Compared to patients with less than 10 days of hospitalization, those with a hospitalization period of 21 days to 30 days (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.0 to 5.2) and 31 days or more (OR, 5.8; 95% CI, 1.9 to 18.1) had a higher risk of PCC. @*Conclusions@#More than a quarter of COVID-19 patients, including those who had no initial symptoms, experienced PCC in Korea. People with the initial symptoms of fever, chills, and respiratory symptoms and those who had prolonged hospital stays had a high risk of PCC.

Exposure to Hazardous Substances and Their Health Effects Among Residents Living Near Three Industrial Waste Incinerators in Korea

Background@#This study aimed to evaluate exposure to various hazardous substances emitted by incineration facilities and their likely effect on the health for residents of Bugi-myeon, Cheongju, Korea, which has three incineration facilities. @*Methods@#Heavy metals, polycyclic aromatic hydrocarbons (PAHs), and dioxin concentrations in the air and soil of exposed and control areas were measured. Moreover, the exposure levels to harmful substances and its effects on health were investigated in 1,124 exposed and 232 control adults. @*Results@#PAHs and dioxin concentrations in the air in the exposed area were significantly higher than in the control area. Urinary cadmium and PAHs metabolite concentrations were significantly higher in the exposed group than in the control group. The exposure group also had a higher prevalence of depression and self-reported allergic symptoms than the control group. @*Conclusion@#The possibility of residents in Bugi-myeon being exposed to hazardous substances at incineration facilities cannot be ruled out. To prevent them from further exposure to hazardous substances, it is necessary to prohibit the expansion of additional incineration facilities in this area and to implement continuous monitoring projects for residents

Long-Term Efficacy and Safety of Eculizumab in Patients With Paroxysmal Nocturnal Hemoglobinuria and High Disease Burden: Real-World Data From Korea

Background@#Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disorder characterized by uncontrolled terminal complement activation. Eculizumab, a monoclonal antibody C5 inhibitor was introduced in Korea in 2009 and has been the standard treatment option for PNH. @*Methods@#This study assessed the long-term efficacy/safety of eculizumab in PNH using real-world data from the Korean Health Insurance Review and Assessment Service. Eighty patients who initiated eculizumab from 2009–2020 were enrolled. @*Results@#At eculizumab initiation, the median age was 51.5 years, lactate dehydrogenase (LDH) 6.8 × upper limit of normal, and granulocyte clone size 93.0%. All patients had at least one PNH-related complication before eculizumab initiation, including renal failure (n = 36), smooth muscle spasm (n = 24), thromboembolism (n = 20), and pulmonary hypertension (n = 15). The median (range) duration of eculizumab treatment was 52.7 (1.0, 127.3) months (338.6 total treated patient-years). Despite high disease activity in the study population before treatment initiation, overall survival was 96.2% and LDH levels were stabilized in most patients during treatment. PNH-related complications at treatment initiation were resolved in 44.4% of patients with renal failure, 95.8% with smooth muscle spasm, 70.0% with thromboembolism, and 26.7% with pulmonary hypertension. Extravascular hemolysis occurred in 28.8% of patients (n = 23; 0.09 per patient-year) and breakthrough hemolysis in 18.8% (n = 15; 0.06 per patient-year). No treatment discontinuation cases related to eculizumab were observed. @*Conclusion@#These data provided evidence for the long-term efficacy and safety of eculizumab in Korean PNH patients with high disease burdens.

The Korean Version of Pandemic Stress Questionnaire: Validation in Korean Population

Objective@#The spread of Coronavirus disease 2019 (COVID-19) has acted as a significant stressor among individuals, causing a variety of psychological problems. The purpose of this study is to determine the level of stress caused by COVID-19 by translating and validating the Pandemic Stress Questionnaire (PSQ) in Korean, which measures stressful event caused by COVID-19. @*Methods@#A statistical analysis was performed on 167 participants. The scale’s internal consistency was verified using Cronbach’s α. Furthermore, a correlation analysis was carried out to examine the relationships between Perceived Stress Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder Questionnaire-7, Patient Health Questionnaire-15, and World Health Organization Quality of Life Assessment Instrument Brief Form. Lastly, a multiple regression analysis was performed to determine the effect of pandemic-related stressful events on depression, anxiety, and somatic symptoms. @*Results@#Cronbach’s α for Korean version of PSQ (K-PSQ) Severity was 0.79, and that for K-PSQ Event was 0.78. The results of the multiple regression analysis revealed that pandemic stress events have an effect on anxiety and somatic symptoms. @*Conclusion@#The K-PSQ is a tool in which individuals can simultaneously measure the occurrence of stressful events caused by COVID-19 and the severity of stress that is often experienced as a result. It is expected that this tool will be useful in the mental health field for measuring COVID-19-related stress.

Development of a Guideline for Antipsychotic-induced Hyperprolactinemia in Korea Using the ADAPTE Process

Objective@#To develop an evidence-based guideline for the diagnosis and treatment of antipsychotic-induced hyperprolactinemia by adapting existing high-quality clinical guidelines with a view to improve the clinical symptoms and long-term quality of life of patients by providing appropriate management. @*Methods@#This guideline was developed according to the ADAPTE methodology. The adaptation process included determining key health questions, systematically searching and screening guidelines, evaluating the quality and contents of these guidelines, deriving recommendations for key questions, and performing a peer review. The selection criteria for the guideline search were (1) evidence-based guidelines, (2) published within the last 5 years, and (3) written in English or Korean. @*Results@#After evaluating the quality and content, we finally selected three guidelines for adaptation. The final output of the development process was 25 recommendations for 10 key questions. We adopted the Agency for Health Research Quality methodology and presented the level of evidence from levels I to IV. In addition, we defined the recommendation grades from grade A (strongly recommended) to D (no recommendation) based on the level of evidence and clinical significance of the recommendation. @*Conclusion@#The development and dissemination of the adapted guideline is expected to increase the certainty of medical decision making and improve the quality of medical care. Further studies on the effectiveness and applicability of the developed guideline are necessary.

Clinical Significance of bZIP In-Frame CEBPA-Mutated Normal Karyotype Acute Myeloid Leukemia / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#We evaluated the characteristics of CCAAT/enhancer-binding protein α (CEBPA) mutations and the significance of a basic leucine zipper in-frame mutation (bZIPin-f) of CEBPA in patients with acute myeloid leukemia with a normal karyotype. @*Materials and Methods@#Based on updated knowledge of CEBPA mutations, we conducted next-generation sequencing analyses in a previously established real-world cohort. @*Results@#Among 78 of a total of 395 patients (19.7%), 50 had bZIPin-f CEBPA, and 28 had non-bZIPin-f CEBPA. In the multivariate analysis, patients with NPM1mut, those with bZIPin-f CEBPA, and those who underwent allogeneic hematopoietic cell transplantation (allo-HCT) had favorable overall survival (OS), but FLT3-ITDmut was a poor prognostic indicator. For relapse-free survival (RFS) and cumulative incidence of relapse, bZIPin-f CEBPA, and allo-HCT were associated with favorable outcomes; FLT3-ITDpos was associated with worse outcomes. In the CEBPA double-mutated group (CEBPAdm), bZIPin-f CEBPA was associated with superior outcomes in terms of OS (p=0.007) and RFS (p=0.007) compared with non-bZIPin-f CEBPA. Of 50 patients with bZIPin-f CEBPA, 36 patients had at least one mutation. When grouped by the presence of mutations in chromatic/DNA modifiers (C), cohesion complex (C), and splicing genes (S) (CCS mutations), CCS-mutated bZIPin-f CEBPA was associated with poor OS (p=0.044; hazard ratio [HR], 2.419) and a trend in inferior RFS (p=0.186; HR, 1.838). @*Conclusion@#Only bZIPin-f CEBPA was associated with favorable outcomes in patients with CEBPAdm. However, some mutations accompanying bZIPin-f CEBPA showed inferior OS; thus, further studies with larger numbers of patients are required for clear conclusions of the significance of bZIPin-f CEBPA.

Changes in the incidence of severe damage in the event of a passenger traffic accident after the mandatory safety belt for all seats

Objective@#In September 2018, the traffic law revision has enforced all passengers in cars to wear seatbelts. Our study aims to investigate the effects of this law revision on fellow passengers involved in car accidents by considering their seatbelt-wearing rate and severity score. @*Methods@#This study is a retrospective observational study. Data were collected from the Emergency Department-based Injury in-depth Surveillance (for the years 2017 and 2019), Korea Disease Control and Prevention Agency. Candidates were patients who visited emergency rooms (ERs) of 23 hospitals from January to December in the years 2017 and 2019. Patients under the age of 15 years or without Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS) data or having accidents on highways were excluded. @*Results@#The total number of patients who visited ERs during the study periods was 91,506 and 14,806 in 2017 and 2019, respectively, and were included in our study. There were more fellow female passengers than male passengers during both the study periods: 5,559 in 2017 (67.9%) and 4,341 in 2019 (66.8%). Compared to 52.2% in 2017, the rate of wearing seatbelts increased to 54.5% in 2019. However, after adjusting for age, sex, use of ambulance, injury time, alcohol use, type of road, and counterpart, multivariate logistic regression revealed that compared to the 2017 group, the odds ratio of severe injuries in the 2019 group was 1.10 (95% confidence interval, 0.98-1.24). @*Conclusion@#Increased rate of wearing seatbelts after imposing the traffic law revision was not satisfactory. Therefore, it is necessary to tighten regulations on fellow passengers without seat belts and improve awareness through public relations.

The influence of changes in-hospital infection control protocols and cardiopulmonary resuscitation environment to treatment outcomes on out-of-hospital cardiac arrest due to the COVID-19 pandemic: a single center retrospective observational study

Objective@#Coronavirus disease 2019 (COVID-19) pandemic has been affecting the safety of hospital healthcare workers and the outcome of out-of-hospital cardiac arrest patients. This study aimed to analyze the influence of the changes inhospital infection control protocols (ICP) and cardiopulmonary resuscitation (CPR) environment on the treatment outcomes of out-of-hospital cardiac arrest patients. @*Methods@#The medical records of patients who visited the emergency room were retrospectively reviewed for the period from March 13, 2019 to March 13, 2021. Patient data were analyzed before and after March 13, 2020, when the “in-hospital CPR guidelines related to COVID-19 infection” was recommended by the Korean Society of Emergency Medicine. We performed a comparison and analysis of the first epinephrine administration time and the intubation time with other CPR-related factors in both groups. The in-hospital return of spontaneous circulation (ROSC) and the over 24-hour survival rate were defined as treatment outcomes. @*Results@#A total number of 453 patients were included in the study. After ICP, the in-hospital ROSC was increased (29.8% vs. 42.1%, P=0.006), whereas the over 24-hour survival rate was decreased (67.2% vs. 40.6%, P=0.001). The time intervals from the hospital visit to the first epinephrine administration—1.0 (0-1.0) vs. 1.0 (0-2.0), P=0.007—and tracheal intubation—1.0 (0-1.0) vs. 1.0 (1.0-2.8), P<0.001—were statistically significantly higher than those before ICP application. In our multivariable analysis, the ICP application and pre-hospital emergency medical service (EMS) response time were factors associated with the treatment outcome. @*Conclusion@#After the application of the ICP, both the first epinephrine administration time and the tracheal intubation time from the patient’s hospital visit were prolonged. The application of ICP and the delayed EMS response time were factors associated with the treatment outcome.

Psychometric Properties of the Korean Version of Functioning Assessment Short Test in Bipolar Disorder

Objective@#The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar disorders designed to assess the main functioning problems experienced by patients. This brief instrument includes 24 items assessing impairment or disability in 6 domains of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. It has already been translated into standardized versions in several languages. The aim of this study is to measure the validity and reliability of the Korean version of FAST (K-FAST). @*Methods@#A total of 209 bipolar disorder patients were recruited from 14 centers in Korea. K-FAST, Young Mania Rating Scale (YMRS), Bipolar Depression Rating Scale (BDRS), Global Assessment of Functioning (GAF) and the World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were administered, and psychometric analysis of the K-FAST was conducted. @*Results@#The internal consistency (Cronbach’s alpha) of the K-FAST was 0.95. Test-retest reliability analysis showed a strong correlation between the two measures assessed at a 1-week interval (ICC = 0.97; p ＜ 0.001). The K-FAST exhibited significant correlations with GAF (r = −0.771), WHOQOL-BREF (r = −0.326), YMRS (r = 0.509) and BDRS (r = 0.598). A strong negative correlation with GAF pointed to a reasonable degree of concurrent validity. Although the exploratory factor analysis showed four factors, the confirmatory factor analysis of questionnaires had a good fit for a six factors model (CFI = 0.925; TLI = 0.912; RMSEA = 0.078). @*Conclusion@#The K-FAST has good psychometric properties, good internal consistency, and can be applicable and acceptable to the Korean context.

Mitochondrial Reactive Oxygen Species Elicit Acute and Chronic Itch via Transient Receptor Potential Canonical 3 Activation in Mice / 神经科学通报·英文版

Mitochondrial reactive oxygen species (mROS) that are overproduced by mitochondrial dysfunction are linked to pathological conditions including sensory abnormalities. Here, we explored whether mROS overproduction induces itch through transient receptor potential canonical 3 (TRPC3), which is sensitive to ROS. Intradermal injection of antimycin A (AA), a selective inhibitor of mitochondrial electron transport chain complex III for mROS overproduction, produced robust scratching behavior in naïve mice, which was suppressed by MitoTEMPO, a mitochondria-selective ROS scavenger, and Pyr10, a TRPC3-specific blocker, but not by blockers of TRPA1 or TRPV1. AA activated subsets of trigeminal ganglion neurons and also induced inward currents, which were blocked by MitoTEMPO and Pyr10. Besides, dry skin-induced chronic scratching was relieved by MitoTEMPO and Pyr10, and also by resveratrol, an antioxidant. Taken together, our results suggest that mROS elicit itch through TRPC3, which may underlie chronic itch, representing a potential therapeutic target for chronic itch.

Epidemiologic features according to age groups of pediatric dental injury in emergency departments

Purpose@#The aim of this study was to investigate the epidemiologic features of pediatric dental injury according to age groups using Korean national data. @*Methods@#We reviewed the data from 2015 to 2019 Emergency Department-based Injury In-depth Surveillance registry, which involves 23 emergency departments in Korea. We included children aged 18 years or younger with the International Classification of Disease, 10th Revision codes related to dental injury. Other or combined codes were excluded. The children were classified by age groups: infants (< 1 year), preschoolers (2-6), schoolers (7-12), and adolescents (13-18). As per the age groups, we compared the clinical characteristics, injury event profiles, and outcomes. @*Results@#The study population (n = 33,020) consisted of 8,900 infants (27.0%), 15,705 preschoolers (47.6%), 5,295 schoolers (16.0%), and 3,120 adolescents (9.4%). Their median age was 3 years (interquartile range, 1-7), and boys accounted for 64.2%. The most common mechanism, type of activity, and place were slip down (14,274 [43.2%]), daily activity (23,777 [72.0%]), and home (19,980 [60.5%]), respectively. Among the injury types, soft tissue injury was most common (24,357 [73.8%]). As for the outcomes, 32,841 (99.5%) children were discharged, and 332 (1.0%) children had severe injury. As the age increased, the frequencies changed as follows. As for the place and type, household injury and soft tissue injury decreased while outdoor injury, such as road traffic injury, and tooth fracture increased (P < 0.001). As for the type of activity, injuries related to exercise/sports and education increased (P < 0.001). Of the sports activity, ball sports increased while kickboard/cycle decreased (P < 0.001). @*Conclusion@#Using the epidemiologic features of pediatric dental injury, it is advisable to establish injury prevention strategies according to the age groups.

Case of Decreased Serum Valproic Acid Concentration During Concomitant Use of Meropenem in Patients with Traumatic Brain Injury / 우울ㆍ조울병

Blood valproic acid levels were decreased in patients with traumatic brain injury who had been using valproic acid to control irritability and aggression, and the symptoms worsened coincident with the administration of meropenem, a carbapenem-based antibiotic. Two weeks after the discontinuation of meropenem, valproic acid levels were restored to an effective therapeutic concentration. Therefore, when valproic acid and carbapenem-based antibiotics are used together, blood valproic acid levels may decrease due to drug interaction, and irritability symptoms may worsen. Thus, close monitoring of serum valproic acid levels is required.

A Study of Dry Mouth and Gastrointestinal Disorders in Patients Taking Antidepressant / 우울ㆍ조울병

Background@#The purpose of this study was to identify the characteristics of dry mouth and gastrointestinal (GI) disorders in antidepressant patients. @*Methods@#The study included 103 antidepressant-taking patients. Antidepressants were classified according to their mode of action. The GI disorders were investigated using the medical records of the patients. The Patient Health Questionnaire-15 and a questionnaire for assessing dry mouth symptoms were used in this study. @*Results@#The score for “overall discomfort due to dry mouth in daily life” (31.72±33.82), “dry mouth at night or in the morning” (47.86±35.87), and “dry mouth during the day” (39.83±31.67) were slightly higher than “discomfort in chewing or swallowing foods”. According to somatization severity, the mean values were 116.36±113.34 in the mild, 213.18±136.98 in the moderate, and 277.59±201.44 in the severe, the between-group difference was significant (F=10.294, p<0.001). According to the class of antidepressants, the mean score was 180.00±147.5 for vortioxetine, 194.25±169.33 for selective serotonin reuptake inhibitors (SSRIs), 223.61±156.70 for serotonin and norepinephrine reuptake inhibitors (SNRIs), 75.00±57.00 for norepinephrine dopamine reuptake inhibitors (NDRIs), 201.67±174.66 for Nassau, and 116.67±132.03 for agomelatine. A total of 67 (65.0%) patients had at least one GI disorder. @*Conclusion@#The study findings are expected to help increase medication compliance in antidepressant patients by better controlling the side effects experienced by the patients.

Serological responses and protection levels in chickens administered with Newcastle disease vaccines

Vaccination against Newcastle disease (ND) is the most effective means of controlling the disease, and these vaccines are commercialized only after their safety and effectiveness have been verified through tests that comply with Korean Standards of National Lot Release for Veterinary Biologics. This study investigated whether a relatively convenient and safe serological test can be used in place of the challenge test using highly virulent ND virus. Hemagglutination inhibition (HI) assay and enzyme-linked immunosorbent assay (ELISA) were considered positive of log2 2 or more and cutoff value of 200 or more, respectively, in both live and inactivated vaccines. However, when the antibody levels of the live and inactivated vaccines induced using the Ulster 2C, KBNP-C4152R2L, and K148/08 strains were compared, the antibody titers for inactivated vaccines were significantly higher than those for live vaccines in both the HI assay and ELISA. A strong positive correlation was observed between HI and ELISA antibody titers. The live vaccines corresponded to a survival rates of ≥ 80% and the inactivated vaccines corresponded to 100% survival rates. This study confirmed that standard efficacy tests can serve as serological tests, and can replace the challenge test and that the vaccine approval process can be improved.

Enhancing the Effect of Placental Extract on the Regeneration of Crush Injured Facial Nerve

There is a scarcity of experimental studies on peripheral nerve regeneration using placental extract (PE). This study aimed to investigate the effects of topical PE application on recovery after crush injury to the rat facial nerve using functional, electrophysiological, and morphological evaluations. The viability of the RSC96 Schwann cells treated with PE (0.5~4 mg/ml) increased significantly. Immunoblot test revealed that PE application enhanced the migration of RSC96 cells. Quantitative polymerase chain reaction demonstrated that PE increased the expression of neurotropic genes. The recovery from vibrissa fibrillation in the PE-treated group was superior to that in the control group. The threshold of action potential was also significantly lower in the PE group. Histopathological examination showed that crushed facial nerves treated with PE exhibited larger axons. The surrounding myelin sheaths were more distinct and thicker in the PE-treated group. Hence, PE may be considered a topical therapeutic agent for treating traumatic facial nerve paralysis.

Head-to-Head Comparison between Xpert MTB/RIF Assay and Real-Time Polymerase Chain Reaction Assay Using Bronchial Washing Specimens for Tuberculosis Diagnosis / 결핵및호흡기질환

Background@#With the introduction of Xpert MTB/RIF assay (Xpert), its incorporation into tuberculosis (TB) diagnostic algorithm has become an important issue. The aim of this study was to evaluate the performance of the Xpert assay in comparison with a commercial polymerase chain reaction (PCR) assay. @*Methods@#Medical records of patients having results of both Xpert and AdvanSure TB/NTM real-time PCR (AdvanSure) assays using the same bronchial washing specimens were retrospectively reviewed. @*Results@#Of the 1,297 patients included in this study, 205 (15.8%) were diagnosed with pulmonary TB. Using mycobacterial culture as the reference method, sensitivity of the Xpert assay using smear-positive specimens was 97.5%, which was comparable to that of the AdvanSure assay (96.3%, p=0.193). However, the sensitivity of the Xpert assay using smear-negative specimens was 70.6%, which was significantly higher than that of the AdvanSure assay (52.9%, p=0.018). Usng phenotypic drug susceptibility testing as the reference method, sensitivity and specificity for detecting rifampicin resistance were 100% and 99.1%, respectively. Moreover, a median turnaround time of the Xpert assay was 1 day, which was significantly shorter than 3 days of the AdvanSure assay (p<0.001). @*Conclusion@#In comparison with the AdvanSure assay, the Xpert assay had a higher sensitivity using smear-negative specimens, a shorter turnaround time, and could reliably predict rifampin resistance. Therefore, the Xpert assay might be preferentially recommended over TB-PCR in Korean TB diagnostic algorithm.

Microbiologic pattern and clinical outcome of non-ICU-acquired pneumonia: Korean HAP registry analysis

Background/Aims@#Most studies on hospital-acquired pneumonia (HAP) have been conducted in intensive care unit (ICU) settings. This study aimed to investigate the microbiological and clinical characteristics of non-ICU-acquired pneumonia (NIAP) and to identify the factors affecting clinical outcomes in Korea. @*Methods@#This multicenter retrospective cohort study was conducted in patients admitted to 13 tertiary hospitals between July 1, 2019 and December 31, 2019. Patients diagnosed with NIAP were included in this study. To assess the prognostic factors of NIAP, the study population was classified into treatment success and failure groups. @*Results@#Of 526 patients with HAP, 379 were diagnosed with NIAP. Overall, the identified causative pathogen rate was 34.6% in the study population. Among the isolated organisms (n = 113), gram-negative bacilli were common pathogens (n = 91), such as Pseudomonas aeruginosa (n = 25), Acinetobacter baumannii (n = 23), and Klebsiella pneumoniae (n = 21). The multidrug resistance rates of A. baumannii, P. aeruginosa, and K. pneumoniae were 91.3%, 76.0%, and 57.1%, respectively. Treatment failure was significantly associated with K. pneumoniae (odds ratio [OR], 3.50; 95% confidence interval [CI], 1.35 to 9.05; p = 0.010), respiratory viruses (OR, 3.81; 95% CI, 1.34 to 10.82; p = 0.012), hematological malignancies (OR, 3.54; 95% CI, 1.57 to 8.00; p = 0.002), and adjunctive corticosteroid treatment (OR, 2.40; 95% CI, 1.27 to 4.52; p = 0.007). @*Conclusions@#The causative pathogens of NIAP in Korea are predominantly gram-negative bacilli with a high rate of multidrug resistance. These were not different from the common pathogens of ICU-acquired pneumonia.

Inhibition of lyosphosphatidic acid receptor 1 signaling in periodontal ligament stem cells reduces inflammatory paracrine effect in primary astrocyte cells

Lysophosphatidic acid (LPA) is a bioactive lipid messenger involved in the pathogenesis of chronic inflammation and various diseases. Recent studies have shown an association between periodontitis and neuroinflammatory diseases such as Alzheimer’s disease, stroke, and multiple sclerosis. However, the mechanistic relationship between periodontitis and neuroinflammatory diseases remains unclear. The current study found that lysophosphatidic acid receptors 1 (LPAR1) and 6 (LPAR6) exhibited increased expression in primary microglia and astrocytes. The primary astrocytes were then treated using medium conditioned to mimic periodontitis through addition of Porphyromonas gingivalis lipopolysaccharides, and an increased nitric oxide (NO) production was observed. Application of conditioned medium from human periodontal ligament stem cells with or without LPAR1 knockdown showed a decrease in the production of NO and expression of inducible nitric oxide synthase and interleukin 1 beta. These findings may contribute to our understanding of the mechanistic link between periodontitis and neuroinflammatory diseases.