Predictors of Dexamethasone Response of Residual Edema by Branch Retinal Vein Occlusion after Bevacizumab Injection

Purpose@#To predict the response to intravitreal dexamethasone (IVD) implant injection in cases where macular edema (ME) caused by branch retinal vein occlusion persists despite intravitreal bevacizumab injection. @*Methods@#Three consecutive (monthly) bevacizumab injections were given to treat ME caused by branched retinal vein occlusion (BRVO) 63 eyes that received additional dexamethasone or bevacizumab injection 1 month later to treat residual ME were retrospectively studied. Each injection group was divided into two subgroups according to ME disappearance status by 6 months after diagnosis. Initial central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), and hyperreflective focus status were compared among the subgroups, as were the changes in these values. @*Results@#At the decision point, the dexamethasone good response subgroups exhibited thicker CRTs and smaller CRT changes than the dexamethasone partial response subgroups (all p < 0.05). The good dexamethasone response subgroup showed smaller SFCT changes, a thicker CRT, and smaller CRT changes than the bevacizumab good response subgroup (all p < 0.05) at the decision point. The cutoff values of the Youden index were 409 μm for the CRT and 62.5 μm for the CRT change (p = 0.002 and p = 0.011, respectively). @*Conclusions@#If ME persists after three bevacizumab injections, IVD more effectively reduces edema if the CRT is thick or if the CRT change is small.

Correlation analysis of gingival recession after orthodontic treatment in the anterior region: an evaluation of soft and hard tissues

Purpose@#The aim of this study was to investigate and identify the main causes of periodontal tissue change associated with labial gingival recession by examining the anterior region of patients who underwent orthodontic treatment. @*Methods@#In total, 45 patients who had undergone orthodontic treatment from January 2010 to December 2015 were included. Before and after the orthodontic treatment, sectioned images from 3-dimensional digital model scanning and cone-beam computed tomography images in the same region were superimposed to measure periodontal parameters. The initial labial gingival thickness (IGT) and the initial labial alveolar bone thickness (IBT) were measured at 4 mm below the cementoenamel junction (CEJ), and the change of the labial gingival margin was defined as the change of the distance from the CEJ to the gingival margin. Additionally, the jaw, tooth position, tooth inclination, tooth rotation, and history of orthognathic surgery were investigated to determine the various factors that could have affected anterior periodontal tissue changes. @*Results@#The mean IGT and IBT were 0.77±0.29 mm and 0.77±0.32 mm, respectively. The mean gingival recession was 0.14±0.57 mm. Tooth inclination had a significant association with gingival recession, and as tooth inclination increased labially, gingival recession increased by approximately 0.2 mm per 1°. @*Conclusions@#In conclusion, the IGT, IBT, tooth position, tooth rotation, and history of orthognathic surgery did not affect labial gingival recession. However, tooth inclination showed a significant association with labial gingival recession of the anterior teeth after orthodontic treatment.

Prevalence and risk factors of peri-implantitis: A retrospective study / 대한치과보철학회지

PURPOSE: The study analyzed the prevalence of peri-implantitis and factors which may have affected the disease. MATERIALS AND METHODS: This study based on medical records and radiographs of 422 patients (853 implant cases) who visited Ewha Womans University Mokdong Hospital Dental Center from January 1, 2012 to December 31, 2016. Generalized estimation equations (GEE) was utilized to determine the statistical relationship between peri-implantitis and each element, and the cumulative prevalence of peri-implantitis during the observation period was obtained by using the Kaplan Meier Method. RESULTS: The prevalence rate of peri-implantitis at the patient level resulted in 7.3% (31 patients out of a total of 422 patients), and at the implant level 5.5% (47 implants out of a total of 853 implants). Sex, GBR, guided bone regeneration (GBR) and functional loading periods had statistical significance with the occurrence of peri-implantitis. Upon analysis of the cumulative prevalence of peri-implantitis in terms of implant follow-up period, the first case of peri-implantitis occurred at 9 months after the placement of an implant, and the prevalence of peri-implantitis showed a non-linear rise over time without a hint of a critical point. CONCLUSION: The prevalence of peri-implantitis at the patient level and the implant were 7.3% and 5.5%, respectively. Male, implant installed with GBR and longer Functional Loading Periods were related with the risk of peri-implantitis.

Evaluation of prognosis related to compliance with supportive periodontal treatment in patients with chronic periodontitis: a clinical retrospective study

PURPOSE: The purpose of this study was to evaluate the prognostic effect of patient compliance with supportive periodontal treatment (PC-SPT). Chronic periodontitis patients were classified based on their compliance level, and factors affecting PC-SPT and the prognosis of PC-SPT were investigated. METHODS: This study selected 206 patients who started SPT after receiving periodontal treatment between 2010 and 2012. Patients who continued SPT through February 2016 were included. The patients were classified according to whether they exhibited complete compliance (100% of visits), excellent compliance (≥70% of visits), incomplete compliance (<70% of visits), or non-compliance (only 2 visits). Patient characteristics that could affect PC-SPT, such as age, sex, distance of the clinic from their residence, implantation, and periodontal treatment, were investigated. The number of newly decayed and extracted teeth, alveolar bone level changes around the teeth and implants, and implant removal were examined to evaluate the prognosis of PC-SPT. RESULTS: Sex and the presence of an implant significantly affected PC-SPT. Additionally, the number of newly decayed and extracted teeth and changes in alveolar bone levels around the teeth and implants were significant prognostic factors related to PC-SPT. CONCLUSIONS: PC-SPT in chronic periodontitis patients will help maintain periodontal health and prevent further periodontal disease.

Infuence of Metabolic Syndrome on Hearing Outcome in Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden sensorineural hearing loss (S-SNHL) has been reported to be associated with hypertension, diabetes mellitus, hyperlipidemia, and stroke in previous studies. The purpose of this study was to confrm whether metabolic syndrome (MS) infuences the hearing outcome of S-SNHL in the Korean population. SUBJECTS AND METHOD: We prospectively investigated the clinical variables of 231 cases of S-SNHL from 2010 March to 2014 February. MS was defned according to the National Cholesterol Education Program Adult Treatment Panel III with Asian modifcations. We analyzed and compared the basic and clinical characteristics, the thresholds of pure tone audiometry (PTA), and the hearing outcomes of patients with MS (MS group) and without MS (NMS group). RESULTS: There were no signifcant differences in the basic characteristics and initial hearing thresholds between the MS and NMS groups; on the other hand, there were signifcant differences in all of the clinical values of MS between the two groups. The average thresholds of final PTA for the MS and NMS groups were 52.9±30.9 dB and 40.5±27.2 dB, respectively, with meaningful diversity (p < 0.01). According to Siegel's criteria, the recovery rate of the NMS group (95/159, 59.7%) was signifcantly higher than those of the MS group (29/72, 40.3%). The proportion of recovery within 5 days after starting the treatment was signifcantly higher of the NMS group (37/95, 39.0%) than those of the MS group (4/29, 13.8%) (p < 0.01). CONCLUSION: The hearing outcome of the NMS group was signifcantly better than those of the MS group.

The prognosis of splinted restoration of the most-distal implants in the posterior region

PURPOSE: The aim of this study was to compare the efficacies of two-implant splinting (2-IS) and single-implant restoration (1-IR) in the first and second molar regions over a mean functional loading period (FLP) of 40 months, and to propose the appropriate clinical considerations for the splinting technique. MATERIALS AND METHODS: The following clinical factors were examined in the 1-IR and 2-IS groups based on the total hospital records of the patients: sex, mean age, implant location, FLP, bone grafting, clinical crown-implant ratio, crown height space, and horizontal distance. The mechanical complications [i.e., screw loosening (SL), screw fracture, crown fracture, and repeated SL] and biological complications [i.e., peri-implant mucositis (PM) and peri-implantitis (PI)] were also evaluated for each patient. In analysis of two groups, the chi-square test and Student's t-test were used to identify the relationship between clinical factors and complication rates. The optimal cutoff value for the FLP based on complications was evaluated using receiver operating characteristics analysis. RESULTS: In total, 234 patients with 408 implants that had been placed during 2005 - 2014 were investigated. The incident rates of SL (P<.001), PM (P=.002), and PI (P=.046) differed significantly between the 1-IR and 2-IS groups. The FLP was the only meaningful clinical factor for mechanical and biological complication rates in 2-IS. CONCLUSION: The mechanical complication rates were lower for 2-IS than for 1-IR, while the biological complication rates were higher for 2-IS. FLP of 39.80 and 46.57 months were the reference follow-up periods for preventing biological and mechanical complications, respectively.

Mechanical and biological complication rates of the modified lateral-screw-retained implant prosthesis in the posterior region: an alternative to the conventional Implant prosthetic system

PURPOSE: The modified lateral-screw-retained implant prosthesis (LSP) is designed to combine the advantages of screw- and cement-retained implant prostheses. This retrospective study evaluated the mechanical and biological complication rates of implant-supported single crowns (ISSCs) inserted with the modified LSP in the posterior region, and determined how these complication rates are affected by clinical factors. MATERIALS AND METHODS: Mechanical complications (i.e., lateral screw loosening [LSL], abutment screw loosening, lateral screw fracture, and ceramic fracture) and biological complications (i.e., peri-implant mucositis [PM] and peri-implantitis) were identified from the patients' treatment records, clinical photographs, periapical radiographs, panoramic radiographs, and clinical indices. The correlations between complication rates and the following clinical factors were determined: gender, age, position in the jaw, placement location, functional duration, clinical crown-to-implant length ratio, crown height space, and the use of a submerged or nonsubmerged placement procedure. RESULTS: Mechanical and biological complications were present in 25 of 73 ISSCs with the modified LSP. LSL (n=11) and PM (n=11) were the most common complications. The incidence of mechanical complications was significantly related to gender (P=.018). The other clinical factors were not significantly associated with mechanical and biological complication rates. CONCLUSION: Within the limitations of this study, the incidence of mechanical and biological complications in the posterior region was similar for both modified LSP and conventional implant prosthetic systems. In addition, the modified LSP is amenable to maintenance care, which facilitates the prevention and treatment of mechanical and biological complications.

Effectiveness of Polydeoxyribonucleotide (PDRN) Material on Murine Subcutaneous Laceration Wounds

PURPOSE: To evaluate the effectiveness of polydeoxyribonucleotide (PDRN) material on murine subcutaneous laceration wounds. METHODS: Subcutaneous laceration wounds were made on the back of mice. The mice were divided into two groups according to method of PDRN applied: Group I (control, general dressing, and management) and Group II (PDRN injection). We evaluated gross findings and histological findings for the groups. RESULTS: A total of 18 mice (9 in the Suture group and 9 with Suture+PDRN) were enrolled. In the mean results of gross finding (5-point Likert scale), the mean gross findings for wounds in the PDRN group were significantly higher than the suture groups on post-operative day 4 and 7 (for day 4, Suture: 2, Suture+PDRN: 3.2; for day 7, Suture: 2.7, Suture+PDRN: 4.2; p<0.05). In the histological analysis of wounds in the Suture+PDRN group after 10 days, re-epithelization and granulation tissue formation were better than the Suture group. In terms of wound-healing grade, re-epithelization and inflammation were not different; however, in the Suture+PDRN group, more granulation tissue formation was noted compared to the Suture group (p<0.05). In addition, the expression of VEGF in the Suture+PDRN group significantly increased compared to the Suture group (Suture: 11170+/-2475, Suture + PDRN: 27243+/-6621, p<0.05). CONCLUSION: The Suture+PDRN group can be used for the early treatment and histological healing of subcutaneous laceration wounds.

The Position of Patients for Safe Central Venous Catheterization Via the Internal Jugular Vein: Prospective Observational Study of Critically Ill Patients

PURPOSE: Carotid artery injuries are common complications during catheterization of the internal jugular vein. To increase successful catheterization, the best position for the reduction of carotid artery injuries was determined. Unlike a previous study, only critically ill patients who needed central venous catheterization in an emergency medical center were included. Three maneuvers were evaluated: Trendelenburg position, head rotation, and adjustments according to ultrasound probe level. METHODS: Eight positions were tested in each patient. The positions were classified by maneuver and ultrasound images of each position were stored. Two factors were determined at each position: "safety width" (the part of the internal jugular vein that did not overlap with the carotid artery) and "overlap width" (the part of the internal jugular vein that did overlap with the carotid artery). RESULTS: Compared with the neutral bed position, safety widths were significantly larger in the Trendelenburg position, and there were no statistical difference in overlap widths. Compared with the non-head rotation position, safety widths were smaller and overlap widths were significantly larger in the 45degrees head rotation positions. Safety widths did-not statistically change safter adjustments for ultrasound probe level. However, changing the ultrasound probe level from the base of Sedillot's triangle to thyroid cartilage significantly decreased overlap widths. Overall, The group of Trendeleberg position, with non-head rotation, whose ultrasound probe level was thyroid cartilage had largest safety widths among 8 groups. CONCLUSION: Among the eight positions tested, the Trendelenburg position (with limited head rotation and adjustments for ultrasound probe level) can reduce carotid artery injuries and increase the successful catheterization of the jugular vein in critically ill patients.

The Position of Patients for Safe Central Venous Catheterization Via the Internal Jugular Vein: Prospective Observational Study of Critically Ill Patients

PURPOSE: Carotid artery injuries are common complications during catheterization of the internal jugular vein. To increase successful catheterization, the best position for the reduction of carotid artery injuries was determined. Unlike a previous study, only critically ill patients who needed central venous catheterization in an emergency medical center were included. Three maneuvers were evaluated: Trendelenburg position, head rotation, and adjustments according to ultrasound probe level. METHODS: Eight positions were tested in each patient. The positions were classified by maneuver and ultrasound images of each position were stored. Two factors were determined at each position: "safety width" (the part of the internal jugular vein that did not overlap with the carotid artery) and "overlap width" (the part of the internal jugular vein that did overlap with the carotid artery). RESULTS: Compared with the neutral bed position, safety widths were significantly larger in the Trendelenburg position, and there were no statistical difference in overlap widths. Compared with the non-head rotation position, safety widths were smaller and overlap widths were significantly larger in the 45degrees head rotation positions. Safety widths did-not statistically change safter adjustments for ultrasound probe level. However, changing the ultrasound probe level from the base of Sedillot's triangle to thyroid cartilage significantly decreased overlap widths. Overall, The group of Trendeleberg position, with non-head rotation, whose ultrasound probe level was thyroid cartilage had largest safety widths among 8 groups. CONCLUSION: Among the eight positions tested, the Trendelenburg position (with limited head rotation and adjustments for ultrasound probe level) can reduce carotid artery injuries and increase the successful catheterization of the jugular vein in critically ill patients.

Novel analysis model for implant osseointegration using ectopic bone formation via the recombinant human bone morphogenetic protein-2/macroporous biphasic calcium phosphate block system in rats: a proof-of-concept study

PURPOSE: The osseointegration around titanium mini-implants installed in macroporous biphasic calcium phosphate (MBCP) blocks was evaluated after incubation with recombinant human bone morphogenetic protein-2 (rhBMP-2) in an ectopic subcutaneous rat model. METHODS: Mini-implants (phi1.8x12 mm) were installed in MBCP blocks (bMBCPs, 4x5x15 mm) loaded with rhBMP-2 at 0.1 mg/mL, and then implanted for 8 weeks into subcutaneous pockets of male Sprague-Dawley rats (n=10). A histomorphometric analysis was performed, and the bone-to-implant contact (BIC) and bone density were evaluated. RESULTS: Significant osteoinductive activity was induced in the rhBMP-2/bMBCP group. The percentage of BIC was 41.23+/-4.13% (mean+/-standard deviation), while bone density was 33.47+/-5.73%. In contrast, no bone formation was observed in the bMBCP only group. CONCLUSIONS: This model represents a more standardized tool for analyzing osseointegration and bone healing along the implant surface and in bMBCPs that excludes various healing factors derived from selected animals and defect models.

A Posterior Petrous Meningioma with Recurrent Vertigo

Meningioma's account for around 15% of all primary brain tumors with some 10% of meningiomas arising in the posterior fossa. In rare cases, a meningioma can form around the endolymphatic sac. When formed in the posterior fossa, meningioma tumors can produce vague, non-specific vertiginous symptoms. Research has observed that a subset of these lesions could produce symptoms indistinguishable from those of Meniere's disease. Therefore, we described the clinical features of a case of posterior petrous meningioma with recurrent vertigo as well as the substantial resolution of symptoms after tumor removal via transmastoid approach.

A Case of Tracheal Compression Caused by a Large Foreign Body in the Esophagus

Foreign bodies that migrate outside the esophagus into the mediastinum or soft tissues usually cause respiratory symptoms. Also, esophageal foreign body granulomas that cause tracheal stenosis, lobar atelectasis, and bronchoesophageal fistulas are reported as complications. Foreign bodies can become lodged above esophageal strictures, and chronically-embedded esophageal foreign bodies can induce stricture formation, although these are less common. This is rare case report that the trachea was directly compressed due to impacted esophagus by foreign body.

Isolated Congenital Incus Anomaly / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A non-progressive and conductive hearing loss with normal eardrum, which has no history of trauma and infection is highly suggestive of a congenital ossicular malformation. Among ossicular anomalies, the most common anomalous ossicle is stapes. However, incus anomaly is sometimes encountered with or without stapes anomaly. The objectives of this study are to describe patterns of incus anomaly, encountered in patients who have a normal eardrum and to analyze their surgical results with special reference to the patterns of incus anomaly. SUBJECTS AND METHOD: We reviewed 26 patients (31 ears) with congenital incus anomaly, which were confirmed through exploratory tympanotomy at Ajou University Hospital from 1994 to 2005. We analyzed temporal bone CT, preoperative and postoperative audiometric findings, and surgical findings. RESULTS: 10 anomalous patterns were detected out of 31 cases of congenital incus anomaly. Incus without its long process was the most common anomalous pattern. In 15 out of 26 cases (57.7%), incus anomaly was associated with stapes anomaly, which was usually unilateral. We could get hearing improvement in 26 out of 31 ears (89.1%). CONCLUSION: Various anomalous patterns of incus were noted in our series. Incus anomaly was often associated with stapes anomaly, which was usually unilateral. The surgical result of incus anomaly was excellent except the cases without stapes.

Congenital Stapes Anomalies with Normal Eardrum

OBJECTIVES: A non-progressive and conductive hearing loss with normal eardrum, but no history of trauma and infection, is highly suggestive of a congenital ossicular malformation. Among ossicular anomalies, stapes anomaly is the most common. The purpose of this study is to describe patterns of stapes anomaly and to analyze its surgical outcome with special reference to its patterns. METHODS: We conducted a retrospective case review. The subjects comprised 66 patients (76 ears) who were decisively confirmed by the exploratory tympanotomy as congenital stapes anomalies without any anomalies of the tympanic membrane and external auditory canal. The preoperative and postoperative audiological findings, temporal bone computed tomography scan, and operative findings were analyzed. RESULTS: There were 16 anomalous patterns of stapes among which footplate fixation was the most common anomaly. These 16 patterns were classified into 4 types according to the status of stapes footplate. Successful hearing gain was achieved in 51 out of 76 ears (67.1%) after surgical treatment. CONCLUSION: Footplate fixation was usually bilateral, whereas stapes anomalies associated with other ossicular anomaly were usually unilateral. The success of the surgical treatment of stapes anomaly might depend on its developmental status of the footplate. Stapes anomalies were detected without any fixed patterns, therefore, it is quite possible to detect a large variety of patterns in future.

Two Cases of Artificial Auricular Reconstruction Using an Epithese / 대한이비인후과학회지

One of the most common uses of osseointegration has been to supply patients with craniofacial defects with a bone-anchored epitheses (BAE). BAEs are usually used in the craniofacial defects such as congenital external ear anomalies or facial defects after cancer surgeries or trauma. We report a case of a 26 year-old woman with traumatic auricular amputation due to a traffic accident 4 years ago and a case of 23 year-old man with congenital ear deformity. They took osseointegrated implantations for an auricular prosthesis and are using it without complications. BAEs can be used with good functional and esthetic outcome for artificial auricular reconstruction.

Management for the Children with Otitis Media with Effusion in the Tertiary Hospital

OBJECTIVES: Recently, new evidence-based recommendations have been introduced for diagnosing and managing otitis media with effusion (OME) in children. However, there are some difficulties to follow the general guidelines in the tertiary hospitals. The purpose is to evaluate the efficiency of antibiotics or antihistamines for treatment of children with OME in the tertiary hospital with a randomized prospective clinical study. METHODS: Eighty-four children with OME who had been diagnosed in the tertiary hospital were randomized to receive 5 different medications for 2 weeks. We prescribed antibiotics (amoxicillin-clavulanate syrup) in Group I (n=16), antibiotics/steroids (prednisolone) in Group II (n=18), antibiotics/antihistamines (ebastine) in Group III (n=15), antibiotics/steroids/antihistamines in Group IV (n=17), and mucolytics (ivy leaf extract) in Group V (n=17) for control. We followed-up children every 2 weeks and evaluated the state of OME at 3 months. RESULTS: Thirty six (42.9%) of 84 children were resolved within average 6.9 weeks after the treatments. Thirty-six (42.9%) were treated with ventilation tube insertion and 12 patients (14.3%) were observed. There was no difference in the resolution rates of OME among the five different protocols (P>0.05). There was no difference in the resolution rates among groups who used steroids, antihistamines, steroids and antihistamines, or other medications to manage 42 children with allergies (P>0.05). CONCLUSION: In the tertiary hospital, the cure rate of children with OME was not as high as well-known, and antibiotics or anti-allergic medications were not more effective than control. We may, therefore, need any other guidelines which are different from the previous evidence-based recommendations, including early operation in the tertiary hospitals.

Effect of Adenotonsillectomy on Inattention and Hyperactivity in Children with Sleep Disordered Breathing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sleep disordered breathing (SDB) is a common problem in otolaryngology and comprises a spectrum of airway disorders that ranges from simple snoring to obstructive sleep apnea. SDB can exhibit problems of behavioral regulation such as inattention, hyperactivity and impulsivity. We aim to assess the effect of adenotonsillectomy on inattention and hyperactivity before and after adenotonsillectomy in children with SDB. SUBJECTS AND METHOD: We selected 19 pediatric patients with SDB, whose tonsils are of grade III or greater and the adenoid-nasopharyngeal ratio was 70% or more. The degree of inattentiveness and hyperactivity was evaluated by ADHD diagnostic system (ADS), trail making test, Wisconsin card sorting test (WCST) and SNAP-IV rating scale. RESULTS: There was significant improvement after adenotonsillectomy in the score of auditory ADS, trail making test, WCST, SNAP-IV rating scale. However, no improvement in postoperative visual ADS was observed. CONCLUSION: Adenotonsillectomy could be recommended to improve inattentiveness and hyperactivity in children with SDB.

A Case of Lymphoepithelial Cyst of Palatine Tonsil / 대한이비인후과학회지

Lymphoepithelial cysts of the oral cavity are rare lesions. The incidence when the number of lymphoepithelial cysts was compared to the total number of oral biopsies was 0.09 percent. Especially, the number of lymphoepithelial cysts originated from palatine tonsil was very small. They have been reported as branchial cleft cysts, branchiogenic cysts and pseudocysts because microscopically resemble each other. The lesions present as a small, well circumscribed, yellowish elevated nodule lined with stratified squamous epithelium surrounded by lymphoid tissue, usually on the floor of the mouth or the ventral or posterolateral surface of the tongue. Less frequent locations include the soft palate, mandibular vestibule, anterior pillar, and retromolar pad. We present a case report of a patient with an lymphoepithelial cyst in the right palatine tonsil presenting with throat discomfort.

Genotypic and Phenotypic Characterization of Enteropathogenic Escherichia coli Isolated from Diarrheal Patients in Gwangju

Enteropathogenic Escherichia coli (EPEC) have been implicated in human diarrhea in several countries. Central to EPEC-mediated disease is its ability to cause intestinal lesions, known as attaching and effacing (A/E) lesion. We investigated 92 EPEC strains isolated from patients with diarrhea in Gwangju for their genotypic and phenotypic characteristics. Sixteen (17.4%) of all strains were found to be typical EPEC because they were bfpA gene positive by PCR. The most of typical EPEC isolates (87.5%) showed a localized adhesion (LA) pattern in Hep-2 cell adherence assay, whereas, only 11 atypical EPEC isolates (14.5%) were adhered to Hep-2 cells in a localized manner. Thirteen of the EPEC strains studied belonged to classical O-serogroups of EPEC and 7 isolates were classified as nonclassical EPEC serogroup and the other isolates could not be serotyped with our antisera. The subtypes of eae, tir, espA and espB genes which are major virulence genes concerned of A/E lesion on chromosome were analyzed by multiplex PCR for finding the original resource. The results showed that the composition of these genes subtypes was homogenous and heterogenous in 12 and 26 isolates, respectively. The others were non-determined type in terms of the gene subtype because of genetic diversity of intimin-coding eae genes. Our findings indicated that EPEC isolates from patients with diarrhea were diverse genetically and phenotypically, which require further study in regard to their virulence and epidemiological significance.