Influence Factors for Duration of Vancomycin Resistant Enterococci's Spontaneous Decolonization

PURPOSE: The aim of this study was to identify the factors influencing the spontaneous decolonization period of vancomycin resistant enterococcus (VRE) species in pediatric patients. METHODS: The medical records of patients presenting positive VRE cultures between January 2005 and November 2010 at a tertiary hospital in Seoul, Korea, were reviewed retrospectively. The subjects were divided into two groups according to the average number of days for decolonization (325 days). Clinical characteristics were compared between shorter VRE colonization patients (325 days, n=110). RESULTS: There were 151 patients who had more than 1 year of follow up period or confirmed of VRE decolonization among patients who were identified with VRE. The average age at the time of initial VRE colonization was significantly younger in shorter decolonization group than in prolonged decolonization group (44.9 months vs 40.9 months, P=0.040). The prolonged decolonization group received more vancomycin treatments after VRE colonization in comparison with patients in shorter decolonization group (7.0% vs 27.2%, P=0.008). CONCLUSIONS: For the duration of VRE colonization, it was found that the initial age of acquiring VRE and use of antibiotics were important factors. Antibiotics should be used properly and precisely in order to treat infectious diseases and to control the colonization of antibiotic resistant bacteria.

The Comparison of Growth and Nutrient Intakes in Children with and without Atopic Dermatitis / 대한지역사회영양학회지

The prevalence of atopic dermatitis (AD) has increased recently all over the world. Several studies worldwide reported growth retardation associated with AD, but few studies were reported in Korea. Therefore, the objective of this study was to identity the differences in growth and nutrient intakes between Korean children with and without AD. The participants were 71 AD children and age, gender-matched 81 control children aged 10 to 36 months. Demographic information was gathered by questionnaires. Height and weight were measured at clinic and health centers. Height and weight for age, and weight for height were converted as deviation in Z scores using World Health Organization Standard. A 24 hour dietary recall method was performed to estimate nutrient intakes. A higher percentage of AD children had insufficient energy and intakes of calcium, phosphorus, iron, zinc and vitamin B2 , defined as intakes lower than 75% of the Dietary Reference Intakes for Korean, compared to the control group (P or = 3 food elimination, was associated with insufficient energy and intakes of calcium, phosphorus, iron, zinc, vitamins A and B2 . In conclusion, children with AD need regular nutrient assessment and education about alternative food choices to avoid r food elimination in order to prevent growth retardation or inadequate nutrient intakes. Further longitudinal studies for growth and nutrient intakes should be performed to understand the patterns of growth in children with AD.

Association between Nutritional Knowledge and Dietary Behaviors of Middle School Children and Their Mothers

Middle-school students (158 boys and 199 girls) and their mothers were asked about nutritional attitudes, nutritional knowledge, dietary habits, and food intake using a questionnaire to examine whether nutritional knowledge and dietary behaviors of mothers affected their children's dietary habits. Nutritional attitude scores (total, 15 points) and nutritional knowledge scores (total, 20 points) of girls were 11.24 and 16.13 points, respectively, which were significantly higher than 10.47 and 15.43 points for boys. Generally, mothers received higher points than their children for all scores surveyed, but the results were not significantly different between boys' mothers and girls' mothers. The mean nutrient adequacy ratio (MAR) was calculated from dietary nutrient intakes to assess overall quality of meals. The results showed that girls had a higher MAR than that of boys (0.89 vs. 0.86, p < 0.01). Relationships among variables were examined by Pearson's correlation coefficient within children and between children and their mothers. Significant positive correlations were observed between nutritional attitudes and knowledge in both boys and girls. In girls, positive correlations between nutritional attitudes and dietary habits, nutritional knowledge and dietary habits, and dietary habits and MAR were also sig-nificant. In boys, only dietary habits and MAR were correlated with those of their mothers. Nutritional attitudes, dietary habits, and the MAR of girls' mothers were significantly correlated with nutritional attitude, dietary habits and the MAR of girls. The results indicate that the influence of mothers on dietary behaviors of children was greater in girls than that in boys, suggesting that a gender-specific nutrition education program is needed for middle school students.

Associated Factors with Severity of Atopic Dermatitis in Children / 대한지역사회영양학회지

The prevalence of atopic dermatitis (AD) has increased over the past decades. A variety of factors are related to the development of atopic dermatitis, including genetics and environmental factors. The purpose of the study was to examine factors associated with severity of atopic dermatitis in 104 children aged 6-60 months. To investigate the association between severity and other factors children were divided into two groups, mild (n = 62) and severe (n = 42) groups, based on SCORAD index which measures the severity of atopic dermatitis. Results showed that family history, family's smoking, period of having AD and the levels of the serum total IgE were significantly higher in severe group. More than 6 months of breastfeeding and weaning after 6 month were not associated with severity of AD, but the number of food eliminated was associated with severity. Only vitamin C intake was significantly different by severity after adjusting for energy intake, family history, family's smoking and period of having AD (p = 0.033). There was no association between the severity of atopic dermatitis and growth of children. This study concluded that the severity of atopic dermatitis was associated with family history, family's smoking, period of having AD, children's serum total IgE, and vitamin C intakes. The result of this study should provide the significant information for better management of AD.

The mRNA expression of MMP-1, TIMP-1, TGF-beta1 in gingival keratocytes from gingival hyperplasia induced by cyclosporine A

PURPOSE: Cyclosporine A (CsA) is a versatile immunosuppresive agent used to prevent graft rejection syndrome and treat autoimmune disease. One of the major side effects associated with CsA is the abnormal gingival hyperplasia. The purpose of this study was to investigate the relationship between the mRNA expression of the MMP-1, TIMP-1, and TGF-beta1 and the concentration of CsA in cultured human gingival keratinocytes. MATERIALS AND METHODS: Gingival keratocytes were obtained from gingival tissues of 4 healthy donors. The cultured gingival keratocytes were incubated with increasing concentrations of CsA (0-2000 ng/ml) for 24 hours and the expression of MMP-1, TIMP-1, and TGF-beta1 were determined by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: The expressions of MMP-1 and TGF-beta1 were not significantly different according to the concentrations of CsA. The expression of TIMP-1 was significantly increased at the CsA concentration of 500 ng/ml. CONCLUSION: We concluded that the gingival hyperplasia induced by CsA was more related with TIMP-1 than MMP-1 or TGF-beta1 on gingival collagen metabolism in patients treated with CsA.

The Healing Effectof Bone Morphogenic Protein with Fibrin Glue on an Injury of the Tendon-Bone Junction / 대한정형외과학회잡지

Purpose: The author hypothesizes that exogenously injected BMP, which is mixed with fibrin glue, can accelerate the healing of a bone-tendon junction injury and increase its holding strength during the early regeneration period. Materials and Methods: A direct injury model of the bone-tendon junction was made using the Achilles tendon-calcaneus bone of 54 rabbits: and the transected Achilles tendon was repaired to its original insertion site using the Krackow method. In Group 1, no additional manipulation was performed. In Group 2, only fibrin glue was injected into the junction between the Achilles tendon and the calcaneus in order to exclude the effect of the fibrin glue. In Group 3, BMP-2 incorporated into the fibrin glue was injected into the junction. The results were evaluated by histological analysis and biomechanical tests at 2, 4, and 8 weeks after surgery. The Kruskal-Wallis test was used for a statistical evaluation. Results: Histological analysis revealed the early appearance of fibrocartilage at 2 weeks in Group 3: the area of the fibrocartilage expanded with time. The biomechanical tests showed significant differences in the maximum stress between Groups 1 and 3, and between Groups 2 and 3, at 2, 4, and 8 weeks. 74.4% of the normal maximum stress was recovered at 8 weeks in Group 3. Conclusion: The combined use of BMP-2 and the fibrin glue can accelerate the healing of an injury of the bone-tendon junction.

The Effect of Heparin on Gene Expression of Collagen, MMP, TGF-beta Isoforms Using Cultured Fibroblast from Transverse Carpal Ligament of Carpal Tunnel Syndrome

PURPOSE: Noninflammatory synovial fibrosis has been noted for main causal factor of carpal tunnel syndrome (CTS). Recently, there are some reports that heparin have not only anti-coagulative effect but also anti-inflammatory and anti-fibrotic potential and have an effect on interstitial pulmonary fiborosis. Authors examined whether heparin affects pathogenesis of CTS. METHODS: First, heparin was administered to fibroblast that was cultured from patient's transverse carpal ligament. Secondly, we evaluated the expression from genes of type I, III collagen, TGF beta isoforms and MMP. Fibroblasts were isolated and cultured from transverse carpal ligaments of 5 patients with CTS. Heparin (0, 1, 10,100microgram/ml) was administered to cultured fibroblast and reverse transcription PCR for mRNA expression of type I, III collagen, TGF-beta isoforms and MMP was done. RESULTS: Heparin suppressed gene expression of type I, III collagen and TGF-beta1, beta3 but promoted gene expression of TGF-beta(2) and MMP-2. CONCLUSION: Heparin directly suppress gene expression of type I, III collagen. But, It is undetermined that heparin can present it's effect mediated by TGF beta iso forms or MMP.

Production, Characterization, and Variable Region Analysis of Monoclonal Antibodies Specific for Hepatitis B Virus S Antigen

BACKGROUND: Hepatitis B virus (HBV) infection is one of the worldwide public health problem affecting about 300 million people. The envelope protein of HBV consists of three components known as preS1, preS2, and S antigen. According to the recent study, anti-HBs Ab showed effective neutralization ability against HBV from chronic hepatitis B and liver transplant patients, suggesting the possible development of therapeutic antibody. METHODS: Spleen cells immunized with S antigen of HBV were fused with myeloma cell line to obtain HBsAg specific monoclonal antibodies. High affinity antibodies against HBsAg (adr, ad and ay type) were selected by competitive ELISA method. Nucleotide sequence of the variable regions of monoclonal antibodies was analyzed by RT-PCR followed by conventional sequencing method. RESULTS: We produced 14 murine monoclonal antibodies which recognize S antigen of HBV. Two of them, A9-11 and C6-9 showed the highest affinity. The sequence analysis of A9-11 revealed that variable regions of the heavy chain and light chains are members of mouse heavy chain I (B) and light chain lambda 1, respectively. Likewise, the sequence analysis of C6-9 revealed that variable regions of the heavy chain and light chains are members of mouse heavy chain II (B) and light chain kappa 1, respectively. Neutralization assay showed that A9-11 and C6-9 effectively neutralize the HBV infection. CONCLUSION: These results suggest that A9-11 and C6-9 mouse monoclonal antibodies can be used for the development of therapeutic antibody for HBV infection.

Studies on the Cellular Immune Response in Animal Model of Arthritis after the Induction of Oral Tolerance

Oral administration of antigen has long been considered as a promising alternative for the treatment of chronic autoimmune diseases including rheumatoid arthritis (RA), and oral application of type II collagen (CII) has been proven to improve pathogenic symptoms in RA patients without problematic side effects. To further current understandings about the immune suppression mechanisms mediated by orally administered antigens, we examined the changes in IgG subtypes, T-cell proliferative response, and proportion of interleukin (IL)-10 producing Th subsets in a time course study of collagen induced arthritis (CIA) animal models. We found that joint inflammation in CIA mouse peaked at 5 weeks after first immunization with CII, which was significantly subdued in mice pre-treated by repeated oral administration of CII. Orally tolerized mice also showed increase in their serum level of IgG1, while the level of IgG2a was decreased. T-cell proliferation upon CII stimulation was also suppressed in lymph nodes of mice given oral administration of CII compared to non-tolerized controls. When cultured in vitro in the presence of CII, T-cells isolated from orally tolerized mice presented higher proportion of CD4+ IL-10+ subsets compared to non-tolerized controls. Interestingly, such increase in IL-10 producing cells were obvious first in Peyer's patch, then by 5 weeks after immunization, in mesenteric lymph node and spleen instead. This result indicates that a particular subset of T-cells with immune suppressive functions might have migrated from the original contact site with CII to inflamed joints via peripheral blood after 5 weeks post immunization.

Healing of Injury of Meniscus Using Fibrin Glue and Meniscal Cell in Rabbit Model / 대한정형외과연구학회지

PURPOSE: We attempt to heal the defect of meniscus using fibrin glue and allogenic meniscal cells in rabbit. MATERIALS AND METHODS: Meniscal cells were isolated from medial meniscus of knee joint of rabbit and cultured and expanded in vitro. The mixture of fibrin glue and meniscal cells implanted to the defect of rabbit meniscus. Examination of gross morphology, histological and immunohistochemical staining of retrieved specimens were performed at 3 and 6 weeks. RESULTS: Cultured cells uniformly displayed an elongated, fibroblastic and fibrocartilagenous morphology. The histological and immunohistochemical analysis revealed regeneration of meniscal tissue at the defect site. CONCLUSION: Meniscal cell transplantation with fibrin glue resulted in the regeneration of meniscus tissue successfully in rabbit model. This approach could be applied for treatment of meniscus injury.

A STUDY ON THE RETENTIVE FORCE OF CIRCUMFERENTIAL CLASP / 대한치과보철학회지

The purpose of this study was to compare the retentive force of cast half round circumferential clasps, cast round circumferential clasps and wrought wire clasps on three different depths of undercut(10G,20G,30G), and to determine the proper amount of undercut for cast round circumferential clasp. Three different lower second premolar crowns were cast and each of clasp was made. Each of clasp affixed to the different types of clasp. Their retentive forces were measured with universal testing machine. The results were as follows: 1. When the depth of undercut was same, the greatest retentive force was exerted by cast half round circumferential clasp, followed by cast round - 33 - circumferential clasp and wrought wire clasp. 2. The degree of variation amount of retentive force according to depth of undercut was greatest for cast round circumferential clasp. 3. Not only elastic deformation but also permanent deformation of the retentive arm was observed after insertion and removal of the clasp. The results of this study show that the retentive force of cast round circumferential clasp falls between those of cast half round circumferential clasp and wrought wire clasp, and suggest that a 20G undercut is suitable for ensuring an appropriate degree of the retentive force.

Vitreous Surgery for Retinal Detachment associated with Acute Retinal Necrosis Syndrome

The acute retinal necrosis syndrome(ARN) is characterized by acute peripheral necrotizing retinitis, occlusive arteritis, and panuveitis. ARN is often complicated by late retinal detachment and a poor visual outcome. We describe herein a series of 4 consecutive patients(5 eyes) with ARN, complicated by retinal detachment. A patient with bilateral ARN(case 1) underwent prophylactic vitrectomy, 360 degrees scleral buckling, and intravitreal injection of acyclovir on the right eye while the retina was attached. Subsequently, the retina became detached. The retina was successfully reattached by performing fluid-gas exchange and laser photocoagulation. Argon laser photocoagulation was performed as a prophylaxis to prevent retinal detachment in two eyes. However, the two retinas subsequently detached. The two eyes were treated with vitrectomy, 360 degrees scleral buckling, fluid-gas exchange, and endolaser photocoagulation. Remaining two eyes required vitrectomy, silicone oil injection, and endolaser photocoagulation with(case 3) or without(case 4) 360 degrees scleral buckling. The retinas remined attached in all five eyes with no additional treatment. Four eyes achieved a visual acutiy of 0.1 or better. One had a final visual acuity of FC/40cm because of macular pucker and optic nerve atrophy.

Transplantation of Cultured Retinal Pigment Epithelium to Rabbit Retina Injured by Sodium Iodate

The authors investigated the possibility of transplanting cultured retinal pigment epithelial (RPE) cells to impaired retina. The authors induced injury of the outer sensory retina and RPE cells with the intravenous injection of 2% sodium iodate in forty pigmented rabbits. Transplantation of RPE cells was done by internal approach with a 30 gauge blunt needle. The neural retina spontaneously reattached within 36 hours. Light microscopic autoradiography showed that some labeled cells were attached to Bruch's membrane as early as in 2 hours and still found in 4 weeks after transplantation. Regeneration of the photoreceptor outer segment and its connection with transplanted RPE cell was not found. Present study demonstrates that cultured rabbit RPE cells can be successfully transplanted to injured rabbit retina if Bruch's membrane is intact. Although the regeneration of the photoreceptor outer segment failed to be demonstrated, further studies are necessary to confirm or disprove these results.

Experimental Corneoacleral Limbal Wound Repair with Cyanoacrylate Glue and 8-0 Vicryl on Rabbits

To evaluate the availability of n-butyl-2-cyanoacrylate as an adhesive in limbal wound repair, we used 15 rabbits(30 eyes). A limbal incision exactly 9mm long was made and the wound of one eye was tightly closed with seven equally apaced corneoscleral sutures of 10-0 nylon(nylon group), The wound of the other eye was closed by two(6.5mm spaced, 11 and 1 o'clock) corneoscleral sutures of 8-0 vicryl and the outer surface of this limbal wound was thinly coated with a small amount of Histoacryl(Histo-acryl group). The average disrupting pressure in nylon group was 0.87 +/- 0.11 kg/cm2 and that in Histoacryl group was 0.79 +/- 0.17 kg/cm2. The average refractive change in nylon group was 2.5 diopter with-the-rule astigmatism, and that in Histoacryl group was 0.9 diopter against-the-rule astigmatism. A moderate inflammatory reaction was noted at the histopathologic findings of the wounds closed with Histoacryl 14 days after operation. From the results, post-operative inflammatory changes indicated that the Histoacryl seemed to be rather unsuitable for clinical application.

A Case of Gronblad-Strandberg Syndrome with Subretinal Neovascularization

The authors experienced one case of Gronblad-Strandberg syndrome with subretinal neovascularization which showed characteristic signs of pseudoxanthoma elasticum(PXE) and angioid streak. PXE is an uncommon hereditary disorder which involves the elastic tissue of the dermis and may also involve the eye and the cardiovascular system. Angioid streaks are red or dark-brown jagged irregular lines extending in spoke like fashion toward periphery from an area of peripapillary atrophy. We report a case of Gronblad-Strandberg syndrome with subretinal neovasculari zation in a 49 year old korean female.

Apparent accommodation in monocular pseudophakic eyes and contact lens wearing monocular aphakic eyes

To investigate the presence of apparent accommodation in monocular pseudopakic eyes and contact lens wearing monocular aphakic eyes, we measured it in 54 monocular pseudophakic eyes (54 patients) and 40 contact lens wearing monocular aphakic eyes (40 patients). The mean apparent accommodation was 1.68+/-1.25 diopters in monocular pseudophakic eyes and 1.74+/-0.73 diopters in contact lens wearing monocular aphakic eyes, and there was no statistically significant difference between them. Apparent accommodation was not related either to type of intraocular lenses or pupil size in pseudophakic eyes and not related to target size in aphakic eyes, but it was influenced by pupil size in aphakic eyes. In the group of patients aged between 45 and 55, accommodation in phakic eyes was significantly greater than apparent accommodation in contralateral contact lens wearing monocular aphakic eyes.

A Case of Takayasu's Arteritis

Takayasu's arteritis is an uncommon arterial inflammatory disease, which causes obliteration of branches of aortic arch and pulmonary artery. It is characterized by absence of pulsation in the upper extremities and associated with ocular, cerebral, and cardiovascular occlusive complications. It affects mainly young Asian females and its etiology is unknown. The authors have experienced a case of Takayasu's arteritis which is associated with Takayasu's retinopthy in a 18 years old female. The fluorescein angiography shows partial delay in filling of choroidal fluorescence, dilated veins, microaneurysm, microemboli, and multiple leakage of retinal vessels.

Simulation of Proliferative Vitreoretinopathy in Pigmented Rabbits

Proliferative vitreoretinopathy(PVR) is the most common cause of failure in retinal reattachment surgery. We performed three different procedures in 20 pigmented rabbits to get a simple model to induce experimental PVR. Rabbits were assigned randomly to three groups(I, II and III). Group I rabbits(5 rabbits, 10 eyes) received normal saline into vitreous cavity, after iatrogenic retinal tear was made. In group n rabbits(8 rabbits, 8 eyes), suspension of retinal pigment epithelium(RPE) and choroid of left eye was transferred into vitreous cavity of right eye. In group III rabbits(7 rabbits, 7 eyes), suspension of RPE and choroid of left eye was transferred into vitreous cavity of right eye after iatrogenic retinal tear was made. We observed the fundus for 2 months with, indirect ophthalmoscope. Incidence of retinal detachment of group I was zero(0/10) , that of group II was 37.5%(3/8), and that of group III was 85.7%(6/7). Electron microscopic findings of vitreous strand of one eye of group n showed central melanocytic core, peripheral fibroblast, and intercellular collagen fibril. Electron microscopic finding of one eye of group III revealed subretinal membrane composed of suspected RPE and glial cell.

Two Cases of Ectopic Lacrimal Gland

Ectopic lacrimal gland which has been observed in the eye and in various sites on the ocular adnexa is an unusual congenital and developmental abnormality. We have recently experienced two cases of ectopic lacrimal gland in the lateral side of bulbar conjunctiva on the right eye in a 14-year-old Korean man and in the medial side of bulbar conjunctiva on the right eye in a 19-year-old Korean man incidentally.

Investigation for General Misconception on Eye Problems: I. About the Myopia and Defective Color Vision in Middle School, High School and College Students

To investigate general misconception on eye problems, we analysed the data from 10 questionnaires about the myopia and defective color vision of protocol type answered by 1344 students of middle school, high school, and college for the first report. The results were as follows: 1. The mean number of correct answer was 3.7. 2. The number of correct answer was related to the school carrier but not to sex, residence, and wearing glasses. 3. The incidence of correct answer to questionnaires about the etiology of disease was relatively lower than those about the treatment.