Relationship Between Rotavirus P6 Infection in Korean Neonates and Histo-Blood Group Antigen: a Single-Center Study

Background@#Rotaviruses are a major cause of pediatric gastroenteritis. The rotavirus P[6] genotype is the most prevalent genotype isolated from Korean neonates but has rarely been reported in other countries. Histo-blood group antigen (HBGA) is known to play an important role in rotavirus infection. We investigated the relationship between rotavirus genotype and HBGA-Lewis blood type in Korean children and explored the reasons for the predominance of rotavirus P[6] strain in Korean neonates. @*Methods@#Blood and stool samples were collected from 16 rotavirus-infected patients. Rotavirus G (VP7) and P (VP4) genotyping was performed using reverse transcription-PCR and sequencing. Lewis antigen phenotypes (Lea /Leb ) were tested, and HBGA-Lewis genotype was determined by sequencing the secretor (FUT2) and Lewis (FUT3) genes. Deduced amino acid sequences and three-dimensional structures of the VP8* portion of the rotavirus VP4 protein were analyzed. @*Results@#All P[6] rotaviruses were isolated from neonates under one month of age, who were negative or weakly positive for the Leb antigen. However, 10 of the 11 non-P[6] rotaviruses were isolated from older children who were Leb antigen-positive. The VP8* amino acid sequences differed among P[6], P[4], and P[8] genotypes. Korean P[6] strains showed a unique VP8* sequence with amino acid substitutions, including Y169 > L169, which differed from the sequences of P[6] strains from other countries. @*Conclusions@#The predominance of the rotavirus P[6] genotype in Korean neonates may be related to the interaction between HBGA-Lewis antigen and the VP8* portion of the VP4 protein, and this information will be helpful in future neonatal vaccine development.

Atypical Multiple Evanescent White Dot Syndrome with Pigmented Patches of Recovery Phase

Purpose@#In the present study, an atypical case of multiple evanescent white dot syndrome (MEWDS) was reported, which thewhite dots of acute phase and the pigmented patches of recovery phase appeared on different location.Case summary: A seventeen years old male with no previous medical history was presented with decreased visual acuity of hisleft eye. On the first visit, his maximum corrected vision was 1.0 in right eye and 0.5 in left eye. The white dots with blurry marginwere noted at the nasal retina on fundus exam. Fundus autofluorescence photography, fluorescein angiography and indocyaninegreen angiography all showed typical foundings of MEWDS. Gradually the vision improved up to 1.0 with maximumcorrection in six weeks, with normalized ellipsoid zone contour. However, multiple panretinal pigmented patches appeared diffusely,not only at nasal, where the previous white spots were noted, but also at temporal. The patient was followed up withoutany medication. Finally, the pigmented lesions were disappeared spontaneously. @*Conclusions@#During the recovery phase of MEWDS, multiple pigmentations may appear in different part of the retina, where thewhite dots were not presented. However, they were disappeared with recovery of clinical symptoms gradually without anytreatment.

Performance Evaluation of the Automated Fluorescent Immunoassay System Rotavirus Assay in Clinical Samples

BACKGROUND: The Automated Fluorescent Immunoassay System (AFIAS) rotavirus assay (Boditech Med Inc., Chuncheon, Korea) is a new rapid antigen test for rotavirus detection. We evaluated the performance of this assay for detecting rotaviruses and their specific genotypes in clinical stool samples. METHODS: AFIAS rotavirus assay was performed in 103 rotavirus-positive and 103 rotavirus-negative stool samples (confirmed by both PCR and ELISA), and its results were compared with those of PCR, ELISA, and immunochromatographic assay (ICA). We evaluated diagnostic sensitivity/specificity, the detectability of rotavirus subtypes, lower limit of detection (LLOD), reproducibility, cross-reactivity, and interference of AFIAS rotavirus assay. RESULTS: Based on PCR and ELISA results, diagnostic sensitivity and specificity of the AFIAS rotavirus assay were both 99.0%. LLOD results showed that the AFIAS assay had sensitivity similar to or greater than ICA and ELISA. High reproducibility was confirmed, and no cross-reactivity or interference was detected. This assay could detect genotypes G1P[8], G2P[4], G3P[8], G4P[6], G4P[8], G8P[4], G8P[8], G9P[4], and G9P[8]. CONCLUSIONS: The AFIAS rotavirus assay showed high reproducibility, sensitivity, and specificity as well as excellent agreement with ELISA, PCR, and ICA. It detected the most common as well as unusual genotypes of rotavirus prevalent in Korea. It could be a useful on-site assay for rapid, convenient, and cost-effective detection of rotavirus infection.

Medical students' satisfaction with clinical clerkship and its relationship with professional self-concept / 한국의학교육

PURPOSE@#Medical students construct their identity as a student physician through clinical clerkship. However, there is a lack of research on the effect of clinical clerkship on professional self-concept formation. The aim of this study is to analyze and ascertain the relationship between medical students' satisfaction with clinical clerkship and professional self-concept.@*METHODS@#This investigation studied 84 third- and fourth-year medical students enrolled in the Ajou University School of Medicine and Graduate School of Medicine. Study measures tools included satisfaction with clinical clerkship and professional self-concept measurement. For data analyses, a descriptive analysis of the research variable characteristics was applied, gender differences in variables by years of medical school were analyzed with t-tests, and correlation analysis was used to check for relationships between variables.@*RESULTS@#We found no statistically significant differences between satisfaction with clinical clerkship with respect to medical school year and gender. While professional self-concept did not show significant differences by year of medical school, we observed statistically significant differences by gender with respect to the subscales of professional practice and communication factor. In addition, satisfaction with clinical clerkship and professional self-concept demonstrated statistically significant positive correlation. The present research was able to confirm that there exists a correlation between medical students' clinical clerkship experience and professional self-concept formation.@*CONCLUSION@#Our study outcomes shows that provision of positive assistance as a measure to enhance satisfaction with clinical clerkship via the curriculum and environmental improvement is envisaged to lead to medical students' professional self-concept formation.

Medical students' satisfaction with clinical clerkship and its relationship with professional self-concept / 한국의학교육

PURPOSE: Medical students construct their identity as a student physician through clinical clerkship. However, there is a lack of research on the effect of clinical clerkship on professional self-concept formation. The aim of this study is to analyze and ascertain the relationship between medical students' satisfaction with clinical clerkship and professional self-concept. METHODS: This investigation studied 84 third- and fourth-year medical students enrolled in the Ajou University School of Medicine and Graduate School of Medicine. Study measures tools included satisfaction with clinical clerkship and professional self-concept measurement. For data analyses, a descriptive analysis of the research variable characteristics was applied, gender differences in variables by years of medical school were analyzed with t-tests, and correlation analysis was used to check for relationships between variables. RESULTS: We found no statistically significant differences between satisfaction with clinical clerkship with respect to medical school year and gender. While professional self-concept did not show significant differences by year of medical school, we observed statistically significant differences by gender with respect to the subscales of professional practice and communication factor. In addition, satisfaction with clinical clerkship and professional self-concept demonstrated statistically significant positive correlation. The present research was able to confirm that there exists a correlation between medical students' clinical clerkship experience and professional self-concept formation. CONCLUSION: Our study outcomes shows that provision of positive assistance as a measure to enhance satisfaction with clinical clerkship via the curriculum and environmental improvement is envisaged to lead to medical students' professional self-concept formation.

Evaluation of a New Multiplex Real-Time PCR Assay for Detecting Gastroenteritis-Causing Viruses in Stool Samples

BACKGROUND: Diarrhea has been the second leading cause of death among children under the age of five, and the rapid and accurate pathogen diagnosis in patients with diarrhea is crucial for reducing morbidity and mortality. A newly developed one-step multiplex real-time PCR assay, the Allplex GI-Virus Assay, was evaluated for its ability to detect six diarrhea-causing viruses (rotavirus, norovirus genogroup I (GI) and genogroup II (GII), enteric adenovirus, astrovirus, and sapovirus) in stool samples. METHODS: The performance of the Allplex assay was compared with those of another multiplex PCR assay (Seeplex Diarrhea-V Ace Detection) and genotyping by sequencing, using 446 stool samples from patients with acute gastroenteritis. RESULTS: The overall agreement rates between the results of the Allplex and Seeplex assays were 98.7% for rotavirus, 99.1% for norovirus GI, 93.3% for norovirus GII, 98.0% for adenovirus, and 99.6% for astrovirus. The overall agreement rates between the Allplex assay and genotyping were 99.1% for rotavirus, 99.1% for norovirus GI, 98.7% for norovirus GII, 89.7% for adenovirus, 98.2% for astrovirus, and 99.8% for sapovirus. In addition, eight rotavirus genotypes, three norovirus GI genotypes, four norovirus GII genotypes, eight adenovirus genotypes, two astrovirus genotypes, and two sapovirus genotypes were detected. CONCLUSIONS: The Allplex assay showed high agreement with Seeplex and genotyping results, and was able to additionally detect sapoviruses. The Allplex assay could be useful in identifying viral gastrointestinal infections in patients with acute gastroenteritis symptoms.

Stress Fracture of the Anterior Atlas Arch Following C1 Posterior Arch Resection for Cervical Myelopathy with Retro-Odontoid Pseudotumor / 대한정형외과학회잡지

Atlas fracture accounts for 1% to 3% of all spinal column injuries and 10% of cervical spine fractures, and is most frequently caused by motor vehicle accidents and falls. Only a few cases involving complications after surgical treatment have been reported. We present a case of anterior atlas arch stress fracture accompanied by worsening neurologic symptoms following atlas posterior arch resection for cervical myelopathy with retro-odontoid pseudotumor.

Electroacupuncture on PC6 prevents opioid-induced nausea and vomiting after laparoscopic surgery / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the treatment time dependence of electroacupuncture (EA) on Neiguan (PC6) for preventing postoperative nausea and vomiting (PONV).</p><p><b>METHODS</b>One hundred and seventy-eight patients, who had received intravenous patient-controlled analgesia (PCA) with Fentanyl, were assigned randomly to three groups using random numbers: a pre-operative EA group (PrEA), a post-operative EA group (PoEA), and a non-acupuncture control group (NC). An anesthetist evaluated the incidence and severity of nausea and vomiting for 48 h after surgery blindly. The main outcomes were severity and freguency of PONV, which were measured with a self-reported questionnaire and a confirmation from the anesthetist. The data were analyzed with ANOVA and Z-test.</p><p><b>RESULTS</b>The incidence of nausea and vomiting was significantly lower in the PrEA group than the NC group during 48 h after surgery (P<0.01, P<0.05). The incidence of vomiting was also significantly lower in the PrEA group than the PoEA group (P<0.05). The PoEA subjects evidenced no significant differences compared with the NC subjects in terms of the incidence of nausea and vomiting (P<0.05). The severity of nausea was significantly lower in the PrEA group than in the NC and PoEA groups (P<0.05).</p><p><b>CONCLUSIONS</b>EA on PC6 is effective in the prevention of PONV, and pre-operative acupuncture is more effective than post-operative acupuncture.</p>

Acute Respiratory Distress Due to Delayed Hematoma after Anterior Cervical Discectomy Fusion / 대한정형외과학회잡지

Hematoma resulting in acute respiratory distress associated with anterior cervical spine surgery is rare; however, it is a serious adverse complication and occurs primarily within postoperative three days and is cured in the hospital. Rarely, delayed hematoma occurs after discharge from the hospital, and treatment of respiration is difficult. In this review, we report on a case of acute respiratory distress due to delayed hematoma following anterior cervical discectomy and fusion, which occurred at postoperative five days.

Closed Traction Reduction as an Initial Management for Subaxial Unilateral Facet Dislocation / 대한정형외과학회잡지

PURPOSE: Subaxial unilateral facet dislocation requires immediate reduction; however, cases of failure with reduction have also been reported. We analyzed the factors preventing closed traction reduction and attempted to determine the efficacy and indications of closed traction reduction. MATERIALS AND METHODS: We selected 26 patients, 17 men and nine women. The average age of the patients in selected group was 49 years (20-69 years). Each patient was first treated with Gardner head traction and closed traction reduction. Each patient was checked for the degree of locking of the dislocated segment, intervertebral disc herniation, the degree of contralateral facet joint subluxation, and accompanied fracture. The effect of the location of the injured segment, age, and sex on closed reduction traction was analyzed. RESULTS: A high rate of unsuccessful closed traction reduction was observed for patients with more than 50% locking of the dislocated facet joint (p=0.039). Intervertebral disc herniation, the degree of contralateral facet joint subluxation, facet joint fracture, and pedicle and lamina fracture were unrelated to the success of closed traction reduction. The location of dislocation and sex showed no statistically significant relevance to failure of closed traction reduction. A high rate of failure was observed for patients younger than 40 years. Of the 26 patients, closed traction reduction was successful for 12 and unsuccessful for 14. CONCLUSION: For patients whose degree of locking of the dislocated facet joint is less than 50%, closed traction reduction using skull traction is considered effective, however, for patients younger than 40 years or with more than 50% locking of the dislocated facet, prompt reduction under general anesthesia and subsequent appropriate surgery is considered beneficial.

Expression of SDF-1alpha and leptin, and their effect on expression of angiogenic factors in mouse ovaries / 대한생식의학회지

OBJECTIVE: Ovarian angiogenesis plays an important role in folliculogenesis. However, little is known about the expression of angiogenic factors during follicular development according to female age. Stromal cell derived factor-1alpha (SDF-1alpha) plays a role in granulosa cell survival and embryo quality as an angiogenic chemokine. Leptin is also involved in folliculogenesis and angiogenesis. This study examined expression of SDF-1alpha and leptin, and their effects on the expression of angiogenic factors in the ovary during follicular development according to female age. METHODS: Ovaries were collected from C57BL mice of two age groups (6-9 weeks and 24-26 weeks) at 6, 12, 24, and 48 hours after 5 IU pregnant mare's serum gonadotropin (PMSG) injection. The expression of ovarian SDF-1alpha and leptin mRNA was evaluated by RT-PCR. In the organ culture experiment, the ovaries were cultured in transwell permeable supports with Waymouth's medium treated with various doses of SDF-1alpha (50-200 ng/mL) or leptin (0.01-1 microg/mL) for 7 days. Then, mRNA expression of vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS), and visfatin were examined in the cultured ovaries. RESULTS: Expression of SDF-1alpha and leptin in the ovary was significantly lower in the aged mouse group compared to the young mouse group (p<0.05). Expression of these two factors increased with follicular development after PMSG administration. SDF-1alpha treatment stimulated visfatin expression in a dose-dependent manner, while leptin treatment significantly increased eNOS expression. CONCLUSION: These results suggest that decrease of ovarian SDF-1alpha and leptin expression may be associated with aging-related reduction of ovarian function. SDF-1alpha and leptin may play a role in follicular development by regulating the expression of angiogenic factors in mouse ovaries.

The Comparison of Multi-level Fusion versus One-level Fusion to the Development of Adjacent Level Degeneration in Anterior Cervical Arthrodesis with PEEK Cage and Plate Augmentation for the Degenerative Cervical Spinal Disorders / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze the effect of multi-level fusion in the development of adjacent level degeneration (ALD) in anterior cervical arthrodesis, as a treatment for degenerative cervical disease. MATERIALS AND METHODS: Retrospectively, we analyzed 127 patients who underwent arthrodesis with PEEK cage and plate construction for the treatment of degenerative cervical disease. The mean patient age was 54.4+/-10.6 years and the average follow-up period was 48.5+/-8.5 months. Group A composed of 55 patients who underwent one level fusion and group B composed of 72 patients who underwent two or three level fusion. We evaluated and compared the severity of ALD, such as the stage of osteophyte formation, the grade of ALD, and the incidence of ALD according to 4 grading system. RESULTS: The stage of osteophyte formation was 1.62+/-0.85 points in group A and 2.43+/-1.14 points in group B (p=0.02). The grade of ADL was 1.71+/-0.94 points in group A and 2.38+/-1.11 points in group B (p=0.01). The incidence of symptomatic ALD (radiculopathy and/or myelopathy) was 3.6% (2/55 cases) in group A and 4.2% (3/77 cases) in group B (p>0.05). CONCLUSION: Multi-level fusion can accelerate the severity of adjacent level degeneration as compared with one level fusion, but there was no correlation in the incidence of symptomatic adjacent level degeneration to the fusion level number after anterior cervical arthrodesis for degenerative cervical diseases.

The influence of GABAAgamma2 genetic polymorphism on the emergence agitation induced by sevoflurane / 대한마취과학회지

BACKGROUND: Sevoflurane is one of the most popular anesthetics, used in pediatric anesthesia, but emergence agitation is more common with using sevoflurane as compared to that with using the other inhalation anesthetics. Sevoflurane exerts its effect on gamma-aminobutyric acid (GABA) ergic transmission. This study aimed to investigate if genetic variations at the GABRgamma2 (single nucleotide polymorphism [SNP] 211037 C/T, nucleotide position 3145 in intron A/G) on the 5q33 chromosome were associated with the development of emergence agitation when sevoflurane is used. METHODS: One hundred fourteen, pre-school aged patients who were to undergo tonsillectomy and adenoidectomy were included in this study. Anesthesia was induced with 5 mg/kg of thiopental sodium, 0.02 mg/kg of atropine and 0.1 mg/kg of vecuronium, and this was maintained with 3% sevoflurane and 50% N2O in oxygen. The incidence of emergence agitation and the emergence agitation scores were assessed at 0 min, 10 min, 20 min and 30 min after arriving at the post anesthetic care unit (PACU). Genomic DNA from peripheral leukocytes was isolated using the QIAamp Blood Minikits and the GABRgamma2 genetic polymorphisms were analyzed by performing polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: There were no significant differences of the emergence agitation scores among the genotypes in the GABRgamma2- SNP211037 C/T and GABRgamma2-nucleotide position 3145 in intron A/G. There was a trend in which the AA group in the GABRgamma2- nucleotide position 3145 in intron A/G has a lower incidence of emergence agitation compared with the non-AA group, but this was without statistical significance (P = 0.07). CONCLUSIONS: There is a possibility that the GABR2 genetic polymorphism may affect the development of emergence agitation when sevoflurane is used in pediatric anesthesia.

Short Coasting of One or Two Days by Withholding Both Gonadotropins and GnRH Agonist Prevents Ovarian Hyperstimulation Syndrome without Compromising the Outcome / 대한불임학회지

OBJECTIVE: To evaluate the effect of short coasting, by withdrawing both gonadotropins and GnRH agonist (GnRHa), on the prevention in severe ovarian hyperstimulation syndrome (OHSS) without compromising pregnancy outcome. METHOD: Thirty-seven women who had been coasted during COH for IVF were coasted when > or =20 follicles > 15 mm with serum E2 level of 4,000 pg/ml were detected. Coasting was initiated for one or two days depending on the status of follicle on ultrasound and serum E2 level. Both gonadotropin and GnRHa were withheld for coasting. Retrospective study was carried and changes of serum E2 levels, number of oocytes retrieved, fertilization rate, pregnancy rate were compared and analyzed. RESULTS: The mean serum E2 level fell from 6,993 pg/ml on the onset of coasting to 3,396 pg/ml on the day of hCG administration. The mean number of oocytes retrieved and fertilization rate were 15.7 and 70.0%, respectively. Fifteen patients were pregnant (40.6%) and implantation rate was 15.2%. Twenty-six (70.3%) patients were coasted for one day and 11 (29.7%) were coasted for two days. The mean decrease rate of serum E2 level was 43% in one day coasting group and 15% (1st day) and 81% (2nd day) in two day coasting group. The pregnancy outcome was similar between the two groups. After coasting, no severe or moderate OHSS occurred in any patients and mild OHSS occurred in 3 (8.1%) patients. CONCLUSIONS: Coasting for one or two days can be used successfully in the prevention of OHSS without compromising IVF cycle outcome.

Clinical Efficacy of Implant Removal after Posterior Spinal Arthrodesis with Pedicle Screw Fixation for the Thoracolumbar Burst Fractures / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical efficacy of implant removal by analyzing the radiological changes after posterior spinal stabilization in patients with thoracolumbar burst fractures. MATERIALS AND METHODS: Fifty-eight patients, who received surgical treatment after a thoracolumbar burst fracture with at least a two year follow-up, were enrolled in this study. An evaluation of the clinical results was based on the VAS score to examine degree of pain and discomfort. The evaluation of the radiological results was performed by measuring the changes in the kyphotic angle of the fractured vertebral bodies and the severity of the collapse of the anterior vertebral height taken after the injury, after fusion and after metal removal on the plain lateral radiograph. RESULTS: The VAS score on pain and discomfort after removing the implants showed a significant decrease from 6.5 to 3.2 and from 5.6 to 2.8, respectively. Overall, the kyphotic angle after removing the implants increased by 3.7 degrees, whereas the anterior height of the fractured vertebral body after removing the implant decreased by 1.5% in correction. CONCLUSION: The removal of implants after posterior arthrodesis in thoracolumbar burst fractures can be performed effectively to relieve the pain and restore flexibility but can result in the progression of kyphosis. However careful consideration should be made before removing an implant in cases of severe initial damage.

Improvement of Pregnancy Rate by the Selection of Early Cleavage Embryos to 2-cell Stage in Human IVF / 대한불임학회지

OBJECTIVE: Evaluation of embryos using early cleavage to 2-cell stage has been proposed, but a critical time-point for selecting embryos is unclear. The aim of the present study is to provide a guideline including critical time-point in the selection of early cleaving embryo for the reduction of multiple pregnancies as well as the increase of pregnancy rate in human IVF. METHODS: This prospective study was performed in 116 cycles from 85 patients who underwent conventional IVF or ICSI at the infertility clinic of Good Moonhwa Hospital from January 2002 to December 2003. Early cleavage (EC) of embryos to 2-cell stage was assessed at 25 h and 27 h postinsemination/microinjection. Embryos that had early cleaved at each time point were designated as EC-1 and EC-2, respectively, while others were designated as non-early cleavage (NEC). RESULTS: At least one early cleavage embryo was observed in 54 (46.6%) for the EC-1 and 84 (72.4%) for the EC-2 of the 116 cycles assessed. Clinical pregnancy rates (PR) were significantly higher in the EC-1 group (66.7%) compared to the EC-2 group (53.6%) or the NEC group (31.2%) (p<0.05). Significant improvement of the pregnancy rate was found when at least two or more embryos were early cleaved at 25 h postinsemination or when the proportion of early cleavage embryo at 25 h postinsemination was higher than 20% (p<0.05). CONCLUSIONS: The critical time-point for the selection of early cleavage embryos with high implantation potential is more effective in 25 h postinsemination/microinjection compared to 27 h. The proportion as well as number of early cleavage embryos is also an important factor for the prediction of pregnancy outcome and the chance of multiple pregnancies. These results demonstrated that the evaluation of early cleavage embryos to 2-cell stage is an easy, simple, and objective method for the selection of good quality embryos suitable for embryo transfer.

Upper Face Characteristics According to the Sa -sang Constitution / 체질인류학회지

This research is a study about constitutional diagnosis through the external appearances. Especialy it is for finding shape differences of the upper -face pictures of moire, according to the Sa -sang constitution. We have collected 113 cases of patients of the Sasang Constitutional Department, including employees of the Kyung -Hee Medical Center and took pictures of moire of upper face and measured 50 points. We analyzed shape differences of the upper face according to the Sasang constitution. Analysing the moire of upper face, the characteristics according to sasang constitution presented. Soyangin had a projected part of left upper face compared with taeumin and soeumin, and taeumin had a projected part of right upper face. With the image of moire, the characteristics of upper face according to sasang constitution was found.