Molecular Markers for Detecting a Wide Range of Trichoderma spp. that Might Potentially Cause Green Mold in Pleurotus eryngii

In Pleurotus sp., green mold, which is considered a major epidemic, is caused by several Trichoderma species. To develop a rapid molecular marker specific for Trichoderma spp. that potentially cause green mold, eleven Trichoderma species were collected from mushroom farms and the Korean Agricultural Culture Collection (KACC). A dominant fungal isolate from a green mold-infected substrate was identified as Trichoderma pleuroticola based on the sequences of its internal transcribed spacer (ITS) and translation elongation factor 1-a (tef1) genes. In artificial inoculation tests, all Trichoderma spp., including T. atroviride, T. cf. virens, T.citrinoviride, T. harzianum, T. koningii, T. longibrachiatum, T. pleurotum, and T. pleuroticola, showed pathogenicity to some extent, and the observed symptoms were soaked mycelia with a red-brown pigment and retarded mycelium regeneration. A molecular marker was developed for the rapid detection of wide range ofTrichoderma spp. based on the DNA sequence alignment of the ITS1 and ITS2 regions ofTrichoderma spp. The developed primer set detected only Trichoderma spp., and no cross reactivity with edible mushrooms was observed. The detection limits for the PCR assay of T. harzianum (KACC40558), T. pleurotum (KACC44537), and T. pleuroticola (CAF-TP3) were found to be 500, 50, and 5 fg, respectively, and the detection limit for the pathogen-to-host ratio was approximately 1:10,000 (wt/wt).

Severe Hypophosphatemia-Induced Acute Toxic-Metabolic Encephalopathy in Continuous Renal Replacement Therapy

Acute toxic-metabolic encephalopathy (TME) is an acute condition of global cerebral dysfunction in the absence of primary structural brain disease. Severe hypophosphatemia leads to muscle weakness and involves the diaphragm but hypophosphatemia-induced TME is very rare. Herein, we report the case of a 43-year-old woman with encephalopathy with severe hypophosphatemia during continuous renal replacement therapy. She presented with features of oliguric acute kidney injury on diabetic kidney disease due to volume depletion. At admission, her mental status was alert but gradually changed to stupor mentation during continuous renal replacement therapy. Her phosphate level was less than 0.41 mEq/L and Glasgow coma scale decreased from 15 to 5. After phosphate intravenous replacement and administration of phosphate-containing replacement solution, the phosphate level increased to 2.97 mEq/L and mental state returned to alert state. This case demonstrates that the level of phosphorus should be observed during continuous renal replacement therapy.

The Effect of Pravastatin on Insulin Resistance in Hyperglycemic Patients / 임상당뇨병

BACKGROUND: The effect of pravastatin on insulin resistance (IR) is controversial and poorly studied in prediabetes. METHODS: This study was performed in hyperglycemic patients at Saint Carollo Hospital from January 1, 2013 to December 31, 2015. Among them, we selected 40 patients (24 prediabetes and 16 new onset diabetes [NOD]) who had been treated with pravastatin 20 mg daily for 2 or 4 months and in whom fasting insulin and fasting glucose had been measured before and after administration of pravastatin. IR was defined as a fasting insulin level ≥ 12.94 µU/mL, homeostasis model for IR (HOMA-IR) ≥ 3.04 or quantitative insulin sensitivity check index (QUICKI) ≤ 0.32. RESULTS: Pravastatin treatment decreased total cholesterol and low-density lipoprotein cholesterol levels by 25.2% and 32.3% respectively (P = 0.000 for all), but did not affect fasting insulin level, HOMA-IR, or QUICKI in total, prediabetes, and NOD groups. Prevalence of IR was significantly different between prediabetes and NOD groups both before and after pravastatin treatment (0% versus 37.5%, P = 0.001), but pravastatin treatment did not affect the prevalence of IR in the prediabetes or NOD group. Fasting glucose level was not significantly different before and after pravastatin treatment in prediabetes (106.8 ± 6.4 mg/dL versus 103.8 ± 8.4 mg/dL, P = 0.223) but was significantly different in the NOD group (171.5 ± 70.1 mg/dL versus 124.4 ± 26.7 mg/dL, P = 0.017). CONCLUSION: Pravastatin treatment did not affect IR or fasting glucose level in hyperglycemic patients. Therefore, we suggest pravastatin can be prescribed to hypercholesterolemic patients with hyperglycemia.

Spinal, Cerebral and Cerebellar Embolism after Injection of N-Butyl-2-Cyanoacrylate in Esophageal Variceal Bleeding

We report a case of spinal, cerebral and cerebellar embolism that occurred following injection sclerotherapy with n-butyl-2-cyanoacrylate for variceal bleeding. The patient had been diagnosed with alcoholic liver cirrhosis and esophageal variceal bleeding. We performed injection sclerotherapy with n-butyl-2-cyanoacrylate. The patient complained of both leg motor weakness and left arm motor weakness after injection and was diagnosed with spinal, cerebral and cerebellar embolism following the n-butyl-2-cyanoacrylate injection. At the follow-up examination, the patient's neurologic symptoms had improved, but left leg motor weakness remained. To our knowledge, this is the first report of a case of multiple embolizations including the spine, cerebrum and cerebellum after n-butyl-2-cyanoacrylate injection for treatment of esophageal variceal bleeding.

Comparison of Safety after Percutaneous Coronary Intervention Between Octogenarians and Counterparts with Coronary Artery Disease

BACKGROUND: Elderly patients usually have comorbid and poor general conditions. They are more likely to have complex coronary lesions with cardiac dysfunction. Percutaneous coronary intervention (PCI) in octogenarians remains controversial. In this study, we determined the safety after PCI for octogenarians and their younger counterparts with coronary artery disease. METHODS: We reviewed 1,057 patients (110 octogenarians vs. 947 younger counterparts) who underwent PCI for coronary artery disease at Saint Carollo Hospital. We analyzed the baseline characteristics, angiographic findings, in hospital mortality, and post procedural complications between the two groups. RESULTS: The mean ages of octogenarians and younger counterparts were 83.1+/-4.5 years and 62.6+/-10.3 years, respectively. The octogenarian group had a significantly (p<0.001) higher ratio of female patients compared to their younger counterpart group (57.3% vs. 27.5%). However, the octogenarian group had a significantly (p=0.035) lower ratio of patients with history of diabetes mellitus compare to their younger counterpart group (22.7% vs. 32.6%). Incidence of acute myocardial infarction in octogenarians was significantly (p<0.001) higher than that in the younger counterparts (43.7% vs. 18.0%). There was no significant difference in admission duration, major complication, or in-hospital mortality between two groups. CONCLUSION: Our results revealed that hospital mortality and incidence of major complications in octogenarians who underwent invasive PCI were not higher than those in their younger counterparts, suggesting that PCI could be safely used in patients aged 80 years or older. However, long-term follow-up data are needed.

Application of the Modified Clavien Classification System to 402 Cases of Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia

PURPOSE: We attempted to evaluate the perioperative complications of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia by using the modified Clavien classification system (MCCS). MATERIALS AND METHODS: Targeting 402 patients who underwent HoLEP for benign prostatic hyperplasia performed by a single surgeon between July 2008 and January 2011, we investigated complications that occurred during and within 1 month after surgery and classified them into grade I to grade V on the basis of the MCCS. If two or more complications occurred in one patient, each complication was graded and counted. RESULTS: The mean age, prostate volume, operation time, hospital stay, and average follow-up period of 402 patients who underwent HoLEP were 68.8 years (range, 52-84 years), 53.2 g (range, 23-228 g), 58.2 minutes (range, 20-230 minutes), 4.5 days (range, 2-7 days), and 9 months (range, 4-27 months), respectively; 78 complications occurred in 71 of the patients (morbidity rate, 17.6%). In MCCS grade I, complications occurred in 54 cases (69.2%); in grade II, complications occurred in 19 cases (24.3%); in grade III, complications occurred in 4 cases (5.1%); and in grade IV, 1 patient required intensive care unit care because of cerebral infarction (1.2%). There were no grade V complications. CONCLUSIONS: The HoLEP-based MCCS complications classification was performed very quickly. However, MCCS, when compared with other measures of endoscopic prostate surgery experiences, including HoLEP, exposed the lack of accuracy in low grade classification and the inability to include late complications.

Holmium Laser Enucleation of the Prostate: Modified Morcellation Technique and Results

PURPOSE: We developed an inverse technique for tissue morcellation by modifying the conventional upward technique and then examined its safety and efficiency. MATERIALS AND METHODS: From July 2008 to December 2010, a total of 389 consecutive patients treated with holmium laser enucleation of the prostate (HoLEP) were enrolled in this study. For tissue morcellation, we used an upward technique for an initial series of 84 patients and an inverse technique for a consecutive series of 305 patients. We compared efficiency and safety between the inverse technique and the upward technique. RESULTS: There were no significant differences in mean age or prostate volume between the two groups. The mean morcellation efficiency was higher in the inverse technique group. The incidence of severe bladder injury was significantly higher in the upward technique group. Regarding the site of bladder injury, 7 and 4 cases of bladder injury occurred in the bladder dome and posterior wall, respectively, in the upward technique group. In the inverse technique group, however, the site of bladder injury was limited to the trigone. We divided our clinical series of patients into the upward technique group and three inverse technique groups on the basis of the timing. The mean morcellation efficiency was significantly higher in all three inverse technique groups than in the upward technique group. However, there was no significant difference in mean morcellation efficiency between the three inverse technique groups. CONCLUSIONS: In conclusion, the inverse technique might be a more effective, safer, and more excellent method of morcellation than the conventional upward technique.

Holmium Laser Enucleation of the Prostate: Modified Morcellation Technique and Results

PURPOSE: We developed an inverse technique for tissue morcellation by modifying the conventional upward technique and then examined its safety and efficiency. MATERIALS AND METHODS: From July 2008 to December 2010, a total of 389 consecutive patients treated with holmium laser enucleation of the prostate (HoLEP) were enrolled in this study. For tissue morcellation, we used an upward technique for an initial series of 84 patients and an inverse technique for a consecutive series of 305 patients. We compared efficiency and safety between the inverse technique and the upward technique. RESULTS: There were no significant differences in mean age or prostate volume between the two groups. The mean morcellation efficiency was higher in the inverse technique group. The incidence of severe bladder injury was significantly higher in the upward technique group. Regarding the site of bladder injury, 7 and 4 cases of bladder injury occurred in the bladder dome and posterior wall, respectively, in the upward technique group. In the inverse technique group, however, the site of bladder injury was limited to the trigone. We divided our clinical series of patients into the upward technique group and three inverse technique groups on the basis of the timing. The mean morcellation efficiency was significantly higher in all three inverse technique groups than in the upward technique group. However, there was no significant difference in mean morcellation efficiency between the three inverse technique groups. CONCLUSIONS: In conclusion, the inverse technique might be a more effective, safer, and more excellent method of morcellation than the conventional upward technique.

Acute Urinary Retention due to Aseptic Meningitis: Meningitis-Retention Syndrome / 대한배뇨장애요실금학회지

Acute urinary retention in aseptic meningitis is rarely encountered, and the diagnosis of aseptic meningitis may be less than straightforward, because its symptoms and neurological signs are occasionally mild or absent. We report a case in which acute urinary retention provided an appropriate indication for the diagnosis of aseptic meningitis as the cause of an undiagnosed fever.

A Study on the Fitness of Adjustable Dental Impression Trays on the Chinese and Japanese / 대한치과보철학회지

PURPOSE: This study was designed to investigate the fitness of adjustable dental impression trays on the Chinese and the Japanese. MATERIAL AND METHODS: Initial design of the adjustable dental trays was developed from the results of the dental arch size of Korean adults. This design was applied to the CAD-CAM process in order to create tray model samples. Simple silicon-base molds were then replicated based on these sample models. Polyurethane injection into the silicon-base molds completed the process of creating a large number of test products. 60 Chinese dental students (male:30, female:30) from the Shanghai Second Medical University and 60 Japanese alumni from the Kumamoto high school (male:30, female:30) were selected for taking irreversible hydrocolloid impression with these trays. The width and length of the impression body were measured on several measuring points by Vernier caliper. The results were analyzed statistically to evaluate the fitness of the trays. RESULTS: 1. Uniform impression material thickness was achieved on the Chinese and Japanese by controlling the width of the tray using stops and beveled guides. The material thickness was generally within the range of 3 mm to 6 mm. 2. In the maxillary tray of the Chinese, average thickness of the impression material of the labial vestibule of the incisal teeth was 6.2 mm, the canine was 5.9 mm and the midpalatal part 10.5 mm and the posterior palatal part 9.7 mm. These were relatively large values. 3. In the mandibular tray of the Chinese, average length of the impression material of the lingual vestibule of first, second premolar contact point was 8.9 mm, the incisal teeth was 7.8 mm and thickness of the labial part of canine was 6.8 mm and premolars 7.0 mm. These were relatively large values. 4. In the maxillary tray of the Japanese, average thickness of the impression material of the labial vestibule of the incisal teeth was 7.4 mm, the canine was 7.7 mm and the midpalatal part 9.1 mm. These were relatively large values. 5. In the mandibular tray of the Japanese, average thickness of the impression material of the labial vestibule of first, second premolar contact point was 8.4 mm, and thickness of the labial part of canine was 7.4 mm. These were relatively large values. CONCLUSION: This adjustable dental tray shows good accuracy to Korean because it was designed by the analysis of the dental arch size of Korean adult model. With this result, it can be applied to Chinese and Japanese, we can take more easy and accurate dental impressions.

The study of shear bond strength of a self-adhesive resin luting cement to dentin / 대한치과보철학회지

PURPOSE: The objective of this study was to compare the bonding characteristics of a new self-adhesive resin cement to dentin, which does not require bonding and conditioning procedure of the tooth surface, and conventional resin cement. The effect of phosphoric acid etching prior to application of self-adhesive resin cement on the shear bond strength was also evaluated. MATERIAL AND METHODS: Fortyfive non-carious human adult molars extracted within 6 months were embedded in chemically cured acrylic resin. The teeth were ground with a series of SiC-papers ending with 800 grit until the flat dentin surfaces of the teeth were exposed. The teeth were randomly divided into 3 experimental groups. In group 1, self-adhesive resin cement, RelyX Unicem (3M ESPE, Seefeld, Germany) was bonded without any conditioning of teeth. In group 2, RelyX Unicem was bonded to teeth after phosphoric acid etching. For group 3, Syntac Primer (Ivoclar Vivadent AG, Schaan, Liechtenstein) was applied to the teeth before Syntac adhesive (Ivoclar Vivadent AG, Schaan, Liechtenstein) and Helibond (Ivoclar Vivadent AG, Schaan, Liechtenstein) followed by conventional resin cement, Variolink II (Ivoclar Vivadent AG, Schaan, Liechtenstein). To make a shear bond strength test model, a plastic tuble (3 mm diameter, 3 mm height) was applied to the dentin surfaces at a right angle and filled it with respective resin cement, and light-polymerized for 40 seconds. All the specimens were stored in distilled water at 37 degree C for 24 hours before test. Universal Testing Machine (Z020, Zwick, Ulm, Germany) at a cross head speed of 1 mm/min was used to evaluate the shear bond strength. The failure sites were inspected under a magnifier and Scanning Electron Microscope. The data was analyzed with One way ANOVA and Scheffe test at alpha = 0.05. RESULTS: (1) The shear bond strengths to dentin of RelyX Unicem was not significantly different from those of Variolink II/Syntac. (2) Phosphoric acid etching lowered the shear bond strength of RelyX Unicem significantly. (3) Most of RelyX Unicem and Variolink II showed mixed fractures, while all the specimens of RelyX Unicem with phosphoric acid etching demonstrated adhesive failure between dentin and resin cement. CONCLUSION: Shear bond strength to dentin of self-adhesive resin cement is not significantly different from conventional resin cement, and phosphoric acid etching decrease the shear bond strength to dentin of self-adhesive resin cement.

A study on the illumination of dental clinic / 대한치과보철학회지

Purpose: This study was designed to investigate the present conditions of illumination techniques in dental clinics in order to contribute improvement of operating environment. This study also aimed exploring qualitative and quantitative luminous intensity required for color temperature in dental clinic illumination, which was a critical part of esthetic dentistry. Materials and methods: A total of forty-eight local dental clinics were selected for sampling a) luminous intensity, and b) color temperature. The author measured the luminous intensity and the color temperature with lux meter and color meter respectively between 12pm and 2pm. The dental unit chair placed in the general operation positions were kept the distance 60 cm, then all dental units were measured three times and averaged. The author measured the luminous intensity and color temperature with both common dental operating light and then without operating light in different office environments. The study was conducted under three conditions: 1. artificial illumination in clear day light 2. artificial illumination in cloudy day light, and 3. artificial illumination alone. Results: The results obtained were as follows. 1. The average luminous intensity in dental clinic lighting was 425 lux which was not sufficient to produce the optimal shade of the patient's teeth. Furthermore, the average luminous intensity even in full operating lighting was 9532 lux which fell short of the required level of 10,000 lux. 2. The average color temperature of all dental clinics surveyed was 5169 K which met the optimal range. However, only 33.3% fell in the correct region between 5,000-5,500 K as 25% were over 5,500 K and 41.6% were below 5,000 K. As a result, 66.7% were under insufficient color temperature conditions. 3. The dental unit chair placed next to a window, hence exposure to natural lighting, had significantly higher luminous intensity and color temperature compared to the dental unit chair which didn't have a window or natural lighting. 4. The data analysis revealed that only 6.3% of the dental clinic were met the standard of the average luminous intensity and color temperature.