Biomechanical Parameters in Arch Building Gait Measured by Gait Analysis System with Pressure Sensor / 대한스포츠의학회지

The objective of study was to compare biomechanical parameters between normal and arch building gait in healthy subjects. A total of 40 feet from 20 healthy adults were evaluated in this study. The participants were asked to walk on a treadmill comfortably at 2 km/hr for 30 seconds. Then, they were asked to walk after making arch building through raising arches with their feet by pulling the big toe toward the heel. Gait parameters such as geometry, center of pressure, maximum force, and maximum pressure were measured in normal and the arch building gait using a gait analysis system equipped with pressure sensor. Arch building gait demonstrated significantly (p0.05) different between the two conditions. Geometry, phase, and time parameters were not significantly (p>0.05) different between the two conditions, either. Although forefoot and midfoot maximum force were significantly decreased in arch building gait compared to those in normal gait, the maximum pressure of forefoot was not significantly changed, indicating decreased area of forefoot contact during arch building gait. The arch building gait moves the center of presser to the hind foot and redistributes the contact area, thus changing the distribution of maximum pressure.

Erratum: Biomechanical Parameters in Arch Building Gait Measured by Gait Analysis System with Pressure Sensor / 대한스포츠의학회지

The funding acknowledgment in this article was omitted as published.

The Effectiveness of Real-Time PCR Assay, Compared with Microbiologic Results for the Diagnosis of Pulmonary Tuberculosis / 결핵및호흡기질환

BACKGROUND: The incidence of tuberculosis (TB) in Korea is relatively high compared to the other Organisation for Economic Co-operation and Development (OECD) countries, with a prevalence of 71 per 100,000 in 2012, although the incidence is declining. Real-time polymerase chain reaction (PCR) has been introduced for the rapid diagnosis of TB. Recently, its advantage lies in higher sensitivity and specificity for the diagnosis of TB. This study evaluated the clinical accuracy of real-time PCR using respiratory specimens in a clinical setting. METHODS: Real-time PCR assays using sputum specimens and/or bronchoscopic aspirates from 2,877 subjects were reviewed retrospectively; 2,859 subjects were enrolled. The diagnosis of TB was determined by positive microbiology, pathological findings of TB in the lung and pleura, or clinical suspicion of active TB following anti-TB medication for more than 6 months with a favorable response. RESULTS: Sensitivity, specificity, and accuracy were 44%, 99%, and 86% from sputum, and 65%, 97%, and 87% from bronchoscopic aspirates, respectively. For overall respiratory specimens, sensitivity was 59%, specificity was 98%, and accuracy increased to 89%. CONCLUSION: Positivity in real-time PCR using any respiratory specimens suggests the possibility of active TB in clinically suspected cases, guiding to start anti-TB medication. Real-time PCR from selective bronchoscopic aspirates enhances the diagnostic yield much more when added to sputum examination.

Immunomodulatory Effects of Kimchi in Chinese Healthy College Students: A Randomized Controlled Trial

This study examined the potential immunomodulatory effects of Kimchi, a traditional fermented Korean vegetable, in healthy Chinese college students. The four-week clinical-trial (randomized, open-label, prospective, controlled) was followed by a one week wash-out period. Healthy Chinese college students (over 20 years of age with a body mass index of 18.5-23.0 kg/m2) volunteered for this study. Forty-three students were randomly classified into two groups, Kimchi (n = 21, supplemented with 100 g of Kimchi per day) or non-Kimchi (n = 22, supplemented with 100 g of radish per day, control) groups. During the four-week intervention period, students were asked to maintain their usual diet and activity, and instructed not to take any medications, functional food products, or dietary supplements. Anthropometrics, nutritional intake, and blood immune parameters (lymphocyte subsets, cytokines, and immunoglobulins) were measured before and after the four weeks of intervention. Thirty-nine students (19 in the Kimchi group, 20 in the non-Kimchi group) finished the study. After the intervention, no significant changes were observed in lymphocyte subsets (T-cell, B-cell, NK cell), pro-inflammatory cytokines (IL-6, TNF-alpha), anti-inflammatory cytokines (IL-4 and IL-10), and immunoglobulins (Ig A, G, and M) between groups in either the Kimchi or non-Kimchi. These results suggest that the short-term consumption of Kimchi has no immunomodulatory effects in healthy Chinese college students.

The anti-obesity effect of Lethariella cladonioides in 3T3-L1 cells and obese mice

The aim of this study was to investigate whether a water extract of L. cladonioides (LC) has an anti-obesity effect in 3T3-L1 cells and obese mice. Treatment of differentiated 3T3-L1 adipocytes with LC caused a significant increase in glycerol release and reduced the protein expression of the adipogenic transcription factors, PPARgamma and C/EBPalpha. In an animal model, obese mice were artificially induced by a high fat diet for 10 weeks. Experimental groups were treated with LC (100 mg/kg/day) by gavage for the next 10 weeks. At the end of experiment, the body weight of the LC group mice was reduced by 14.2% compared to the high fat diet (HFD) group. The treatment also decreased liver (31.0%), epididymal (18.0%) and retroperitoneal (19.3%) adipose tissue, and kidney (6.7%) weights, respectively, compared with those of the HFD group. LC prevented diet-induced increases in the serum level of TC (22.6%), TG (11.6%), and glucose (35.0%), respectively, compared with the HFD group. However, the HDL-C level was higher in the LC group (26.1%) than the HFD group. The results of this study thus suggest that LC suppressed lipid accumulation and expression of adipogenic transcription factors, and increased the amount of glycerol release. LC also indicated an anti-obese and anti-hyperlipidemic effect.

Analysis on Stress and Dietary Attitudes of Male Employees / 대한지역사회영양학회지

This study was conducted to vitalize life through analysis on lifestyles, stress and dietary habits of male employees. For this study, questionnaire survey and physical measurements to examine BMI and waist circumference were performed with male employees in four companies located in Gyeongnam. Total 350 copies of the questionnaire were distributed and 327 ones were finally analyzed. The results of analysis on dietary life-related problems and stress were as follows. First, according to BMI, 56.9% were overweight and waist circumference recorded less than 90 cm in 90.5%. For lifestyles, 54.1%, 79.2%, 60.9% and 52.3% smoked, drank alcohol, didn't exercise and didn't sleep sufficiently. Second, for the correlation with job stress, the subjects graduating junior college or lower academic institution, production employees and sleeping insufficiently showed higher compared to the others. Analysis on the correlation with life stress found that conjugal relation stress was higher in alcohol-drinkers, the males not taking dietary supplements, those with a normal weight or more compared to underweight ones. Stress from relation with a child was higher aged 35~49 years than in those aged 20~34 years, and stress from economic life was higher aged less than 50 years, in those graduating junior colleges compared to those graduating colleges, in those sleeping insufficiently. Health life stress was found to be higher in those without religion compared to those with it such as Protestant Christianity and Catholicism, in alcohol drinkers and in those sleeping insufficiently and having a disease. Based on this, in order to improve the lifestyles and dietary habits and release stress effectively, practical nutrition education program should be carried out.

The Efficacy of Core Strengthening on the Trunk Balance in Patients with Subacute Stroke

OBJECTIVE: To investigate the efficacy of core strengthening on trunk balance in patients with subacute stroke. METHOD: Fifty-nine subacute hemiparetic stroke in-patients participated in this study. All patients were randomly assigned to one of two groups: the control group and the experimental group. Both groups received the same conventional physical therapies for 4 weeks. The experimental group received an additional core strengthening program (CSP). Korean mini-mental state examination (K-MMSE) and Korean Modified Barthel Index (K-MBI) were performed on admission. CSP was performed for 30 minutes a day, 3 days per week for 4 weeks. We selected nine exercises available for stroke patients, and divided them as three steps according to the degree of difficulty. Because of the muscle weakness in stroke patients, a physical therapist often helped them during exercise. Outcome measurement included trunk control test (TCT), trunk impairment scale (TIS), and Berg balance scale (BBS) and we compared both groups before and after the period of training. RESULTS: There were no significant differences in baseline general characteristics and initial values between the two groups. After rehabilitation therapy, both groups showed significant improvements in BBS, TIS, and TCT (p<0.05). Following 4 weeks of therapy, changes of BBS, TIS score in the experimental group were significantly higher than those of the control group (p<0.05). However, the change of TCT score was not significantly different. CONCLUSION: Analysis of different clinical parameters showed that better outcomes in BBS, TIS scores were achieved from CSP. This study suggests that CSP conducted for 4 weeks may be beneficial as a therapeutic technique for use in improvement of trunk balance in patients with subacute hemiparetic stroke.

Disseminated Mycobacterium avium complex infection in a patient with AIDS and fever of unknown origin / 대한내과학회지

Since the first AIDS case was reported in 1985, the number of patients with AIDS and infectious complications has been increasing in Korea. Mycobacterium avium complex (MAC) infection is a common opportunistic infection in patients with AIDS, especially those with lower CD4+T cell counts. Although MAC is a common systemic bacterialinfection in developed countries, few cases have been reported among AIDS patients in Korea. MAC infection is rare in an immunocompetent person, but is an important cause of morbidity and mortality in patients with AIDS. MAC infection is typically associated with the degree of immunosuppression, duration of HIV infection, and low CD4+T cell counts. Here we report a case of disseminated MAC infection in an AIDS patient with fever, mesenteric lymph node enlargement, and pancytopenia.

Clinical Evaluation of the Multiplex PCR Assay for the Detection of Bacterial Pathogens in Respiratory Specimens from Patients with Pneumonia / 대한임상미생물학회지

BACKGROUND: Community-acquired pneumonia (CAP) is a major infectious disease with significant morbidity and mortality worldwide. Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila, and Bordetella pertussis are common pathogens of CAP; however, the conventional methods used to detect these agents, including culturing, lack sensitivity and are time-consuming. We evaluated a recently developed multiplex PCR assay which can test these agents simultaneously. METHODS: One hundred patients with pneumonia and 99 healthy adults were tested using the Seeplex Pneumobacter ACE Detection assay (Seegene, Inc., Seoul, Korea). Culture and urinary antigen tests were also performed. RESULTS: In patients with pneumonia, the positive detection rates of PCR for S. pneumoniae and H. influenzae were 52.0% (52/100) and 30.0% (30/100), respectively, those of M. pneumoniae and L. pneumophila were 2.0% (2/100) and 1.0% (1/100), respectively, and B. pertussis and C. pneumoniae were not detected. In healthy adults, the detection rates of S. pneumoniae and H. influenzae revealed similar results, 53.5% (53/101) and 40.4% (40/101), respectively, and the other four pathogens were not detected. The sensitivity and specificity of PCR for S. pneumoniae in pneumonia patients were 100% (95% confidence interval [CI], 87.9~100%) and 65.7% (95% CI, 55.2~76.5%), respectively, according to the urinary antigen test and cultures of the respiratory samples and blood. CONCLUSION: Differentiating S. pneumoniae and H. influenzae colonization from infection was difficult using the PCR assay. Therefore, the use of this assay is inappropriate for the diagnosis of pneumonia due to these agents, although multiplex PCR assay would be useful for the detection of M. pneumoniae and L. pneumophila.

Influence of rebonding procedures on microleakage of composite resin restorations / 대한치과보존학회지

During a composite resin restoration, an anticipating contraction gap is usually tried to seal with low-viscosity resin after successive polishing, etching, rinsing and drying steps, which as a whole is called rebonding procedure. However, the gap might already have been filled with water or debris before applying the sealing resin. We hypothesized that microleakage would decrease if the rebonding agent was applied before the polishing step, i.e., immediately after curing composite resin. On the buccal and lingual surfaces of 35 extracted human molar teeth, class V cavities were prepared withthe occlusal margin in enamel and the gingival margin in dentin. They were restored with a hybrid composite resin Z250 (3M ESPE, USA) using an adhesive AdperTM Single Bond 2 (3M ESPE). As rebonding agents, BisCover LV (Bisco, USA), ScotchBond Multi-Purpose adhesive (3M ESPE) and an experimental adhesive were applied on the restoration margins before polishing step or after successive polishing and etching steps. The infiltration depth of 2% methylene blue into the margin was measured using an optical stereomicroscope. The correlation between viscosity of rebonding agents and mciroleakage was also evaluated. There were no statistically significant differences in the microleakage within the rebonding procedures, within the rebonding agents, and within the margins. However, when the restorations were not rebonded, the microleakage at gingival margin was significantly higher than those groups rebonded with 3 agents (p < 0.05). The difference was not observed at the occlusal margin. No significant correlation was found between viscosity of rebonding agents and microleakage, except very weak correlation in case of rebonding after polishing and etching at gingival margin (r = -0.326, p = 0.041).

Increase of Ceftazidime- and Fluoroquinolone-Resistant Klebsiella pneumoniae and Imipenem-Resistant Acinetobacter spp. in Korea: Analysis of KONSAR Study Data from 2005 and 2007

PURPOSE: Antimicrobial resistance monitoring could be a useful source of information for treating and controlling nosocomial infections. We analyzed antimicrobial resistance data generated by Korean Hospitals and by a commercial laboratory in 2005 and 2007. MATERIALS AND METHODS: Susceptibility data for 2005 and 2007 were collected from 37 and 41 hospitals, respectively, and from one commercial laboratory. Intermediate susceptibility was not included in the calculation of resistance rates. RESULTS: Methicillin-resistant Staphylococcus aureus (MRSA) (64%), third-generation cephalosporin-resistant Klebsiella pneumoniae (29%), fluoroquinolone-resistant Escherichia coli (27%), Pseudomonas aeruginosa (33%), and Acinetobacter spp. (48%), and amikacin-resistant P. aeruginosa (19%) and Acinetobacter spp. (37%) were prevalent in hospitals in 2007. A gradual increase of vancomycin-resistant Enterococcus faecium and imipenem-resistant Acinetobacter spp. was observed. Higher incidences of third-generation cephalosporin-resistant E. coli and K. pneumoniae and imipenem-resistant P. aeruginosa were found in the commercial laboratory than in the hospitals. CONCLUSION: Methicillin-resistant S. aureus, third-generation cephalosporin-resistant K. pneumoniae, and fluoroquinolone-resistant E. coli, P. aeruginosa and Acinetobacter spp. remain prevalent in Korea, while the incidence of vancomycin-resistant E. faecium and imipenem-resistant Acinetobacter spp. has increased gradually. The higher prevalences of third-generation cephalosporin-resistant E. coli and K. pneumoniae, and imipenem-resistant P. aeruginosa in the commercial laboratory are a new concern.

Clarithromycin and Amoxicillin Susceptibility Testing of Helicobacter pylori by Disk Diffusion Method / 대한임상미생물학회지

BACKGROUND: CLSI provides a guideline only for a agar dilution method of testing clarithromycin susceptibility for Helicobacter pylori. This study was to evaluate a disk diffusion method for clarithromycin and amoxicillin. METHODS: One hundred and forty clinical isolates of H. pylori isolated from May 2005 to May 2007 were tested by the CLSI agar dilution method and a disk diffusion method using 2microgram (2CLR) and 15microgram (15CLR) clarithromycin disks and 2microgram (2AMX) and 10microgram (10AMX) amoxicillin disks. The interpretation criteria used for the disk diffusion method were established by linear regression and error rate-bounded method for disk diffusion zone of inhibition (DDZ) compared to MIC. RESULTS: Resistance and intermediate rates to clarithromycin were 21.4% and 1.4%, respectively. A number of isolates with MIC 0.5, 1, and 2 (microgram/mL) to amoxicillin were 7, 2, and 1, respectively. For 2CLR and 15CLR, the coefficients of determination (R2) between MIC and DDZ were 0.931 and 0.923 (P< 0.001), respectively, and the criteria for resistance/ susceptibility were 12/28 mm for 2CLR and 23/39 mm for 15CLR. For 2AMX and 10AMX, the R2 between MIC and DDZ were 0.478 and 0.421 (P< 0.001), respectively, and the criteria for resistance with breakpoint of 2microgram/mL were 21 mm for 2AMX and 32 mm for 10AMX. All isolates had DDZ<60 mm with 2CLR and 2AMX, but 61.4% and 75.7% of the isolates had DDZ<60 mm with 15CLR and 10AMX, respectively. CONCLUSION: Excellent correlation and agreement between MIC and DDZ were found for clarithromycin and amoxicillin. With 2microgram disks, the susceptibility breakpoints were 28 mm or less; thus, two disks could be tested in one plate.

Association between Genotypes and Gastric Mucosal Lymphocytes in Helicobacter pylori-infected Children / 대한소아소화기영양학회지

PURPOSE: Helicobacter pylori infection is probably acquired in childhood and persists as an asymptomatic infection for decades in most individuals. It is unclear why only a minority of those infected develop a clinical manifestation, even in childhood, such as peptic ulcer disease. H. pylori infection activates local immune responses and causes lymphocyte infiltration in the gastric mucosa. We have previously reported that both T and B cells in the lamina propria play important roles in the local immune response of H. pylori-infected children. The aim of this study was to investigate the association between H. pylori genotypes and gastric mucosal lymphocytes. METHODS: Twenty-five H. pylori-infected children (10 with peptic ulcer disease and 15 with gastritis) were enrolled in this study. We investigated the genotypes (cagA, cagE, vacA, and babA2) and evaluated the association with clinical manifestations, histopathology, and gastric mucosal lymphocytes. RESULTS: The prevalence of cagA, cagE, vacA s1m1, and babA2 was 80%, 60%, 84%, and 88%, respectively. The most prevalent (68%) combination of cagA, vacA, and babA2 genotypes was cagA+/ vacA s1m1+/babA2+. H. pylori genotypes were not associated with clinical manifestations, histopathology, or gastric mucosal lymphocytes. CONCLUSION: There was no association between the cagA, cagE, vacA, or babA2 status and gastric mucosal lymphocytes. The role of the host immune response in relation to H. pylori genotypes and disease potential in children needs further studies.

Hemoglobin Yamagata: Hemoglobin Variant Detected by HbA1c Test / 대한진단검사의학회지

Hemoglobin (Hb) Yamagata is a rare Hb variant, which has been reported only twice-one case each in Japan and Korea. This variant arises from a Lys --> Asn substitution due to a mutation of AAA to AAC or AAT at codon 133 of the beta-globin gene. This study reports the third case of a patient detected with Hb Yamagata [HBB: c.399A>T; p.Lys133Asn] and discusses the effect of this variant on HbA1c measurement. This variant was detected in a 70-yr-old Korean man with diabetes mellitus during a routine follow-up. The HbA1c concentration determined using Variant ll Turbo (Bio-Rad, USA) was abnormally high at 47.9%. It was impossible to measure the HbA1c level accurately using Variant ll Thalassemia Mode (Bio-Rad, USA). However, the HbA1c levels analyzed by HLC-723 G7 (Tosoh, Japan), Cobas Integra (Roche, Switzerland) and NycoCard (Axis-Shield, Norway) were 5.0%, 8.0%, and 7.9%, respectively. This study shows that Hb Yamagata interferes with the accurate measurement of HbA1c levels in a diabetic patient. Taking these findings into consideration, we think that an immunoassay or affinity chromatography can be used as an alternate method for measuring the HbA1c level in a patient with this variant. In conclusion, a patient can be inferred to have an Hb variant if the HbA1c concentration is abnormally high or low or if there is a discrepancy between the results obtained using different methods, and if the clinical status of the patient suggests the presence of abnormal Hb. Subsequently, the HbA1c values can be determined by methods based on different principles.

Clinical Usefulness of Real-time PCR and Amplicor MTB PCR Assays for Diagnosis of Tuberculosis / 대한임상미생물학회지

BACKGROUND: PCR assay has provided a mean of more rapid and sensitive detection of Mycobacterium tuberculosis (MTB) complex than conventional acid- fast bacilli (AFB) smears and MTB cultures. Using the recently developed AdvanSure TB/NTM kit (LG Life Science Diagnostic Division, Korea), which could differentiate nontuberculous mycobacteria (NTM) from MTB, this study compared clinical usefulness of real-time PCR assay and Amplicor MTB PCR assay (Roche Molecular Systems, USA) for diagnosis of tuberculosis. METHODS: A total of 213 specimens (148 respiratory and 65 nonrespiratory specimens) were tested by using real-time PCR, Amplicor MTB PCR, AFB smear, and MTB culture. The sensitivity and specificity of four methods were evaluated according to clinical diagnosis. RESULTS: Of six NTM grown in culture, four (67%) were detected by real-time PCR. The overall agreement of real-time and Amplicor MTB PCR was 92% (191/207). The overall sensitivity and specificity were 91% and 87%, respectively, for real-time PCR, and 86% and 93% for Amplicor MTB PCR. In nonrespiratory specimens, the sensitivities of real-time PCR, Amplicor MTB PCR, AFB smear, and MTB culture were 67%, 60%, 13%, and 40%, respectively, and the specificity of the four methods were all 100%. CONCLUSION: For diagnosis of tuberculosis, the sensitivity and specificity of the real-time PCR assay using AdvanSure TB/NTM kit and Amplicor MTB PCR were similar, and the former could differentiate NTM from MTB. The PCR assay can be considered as a more sensitive technique for the detection of MTB than the conventional AFB smear and culture.

Antibiotic-Associated Diarrhea: Candidate Organisms other than Clostridium Difficile

BACKGROUND/AIMS: The direct toxic effects of antibiotics on the intestine can alter digestive functions and cause pathogenic bacterial overgrowth leading to antibiotic-associated diarrhea (AAD). Clostridium difficile (C. difficile) is widely known to be responsible for 10~20% of AAD cases. However, Klebsiella oxytoca, Clostridium perfringens, Staphylococcus aureus, and Candida species might also contribute to AAD. METHODS: We prospectively analyzed the organisms in stool and colon tissue cultures with a C. difficile toxin A assay in patients with AAD between May and December 2005. In addition, we performed the C. difficile toxin A assays using an enzyme-linked fluorescent assay technique. Patients were enrolled who had diarrhea with more than three stools per day for at least 2 days after the initiation of antibiotic treatment for up to 6~8 weeks after antibiotic discontinuation. RESULTS: Among 38 patients (mean age 59+/-18 years, M:F=18:20), the organism isolation rates were 28.9% (11/38) for stool culture, 18.4% (7/38) for colon tissue cultures and 13.2% (5/38) for the C. difficile toxin A assay. The overall rate of identification of organisms was 50.0% (19/38). Of the five patients that had a positive result by the C. difficile toxin A assay, two had no organism isolated by the stool or colon tissue culture. The organisms isolated from the stool cultures were C. difficile (4), Klebsiella pneumoniae (K. pneumoniae) (3), Candida species (3), and Staphylococcus aureus (1). C. difficile (4) and K. pneumoniae (3) were isolated from the colon tissue culture. CONCLUSIONS: For C. difficile negative AAD patients, K. pneumoniae, Candida species, and Staphylococcus aureus were found to be potential causative organisms.

Evaluation and Establishment of Reference Range of Automated Urine Cell Analyzer UF-100 / 임상검사와정도관리

BACKGROUND: The automated urine cell analyzer UF-100 (Syxmex co., Japan), flow cytometer-based instrument, has enabled to perform rapid and efficient work. We evaluated the UF-100 by comparing performance in urine sediment testing with counting chamber, standardized method, and traditional manual microscopy widely used in laboratories, and established reference ranges in our hospital. METHODS: Urine samples were obtained from patients in their 20s to 60s who visited hospital for regular check-up between March and April 2007 at Ewha Womans University Mokdong Hospital. We selected randomly a total of 261 samples (male 130, female 131) and evaluated correlations of red blood cell (RBC) and white blood cell (WBC) counts of UF-100 with counting chamber, and manual microscopy. Moreover, we established reference ranges of UF-100 and counting chamber according to CLSI guideline, using 156 urine samples (male 93, female 63) with normal dipstick (strip) test results. RESULTS: The RBC correlation coefficients between UF-100 and counting chamber, UF-100 and manual microscopy, counting chamber and manual microscopy were 0.538, 0.873, and 0.619, respectively. The WBC correlation coefficients between UF-100 and counting chamber, UF-100 and manual microscopy, counting chamber and manual microscopy were 0.992, 0.902, and 0.893, respectively and showed good correlations. The results of UF-100 were higher than counting chamber and manual microscopy. The RBC reference ranges of UF-100 nd counting chamber were 0.5-24.9/microliter (male 0.4-12.2/microliter, female 0.9-38.8/microliter) and 0-4/microliter (male 0-4/microliter, female 0-5/microliter), and the WBC reference ranges of those were 0.9-21.8/microliter (male 0.8-12.6/microliter, female 2.0-23.4/microliter) and 0-7/microliter (male 0-7/microliter, female 0-9/microliter). CONCLUSIONS: The fully automated analyzer UF-100 could be useful to enhance efficiency by labor-saving, turnaround time reduction and improving throughput and to enable standardization. But it is needed for further study including clinical evaluation, because the results and reference ranges between UF-100 and counting chamber or manual microscopy showed considerable differences.

Evaluation and Establishment of Reference Range of Automated Urine Cell Analyzer UF-100 / 임상검사와정도관리

BACKGROUND: The automated urine cell analyzer UF-100 (Syxmex co., Japan), flow cytometer-based instrument, has enabled to perform rapid and efficient work. We evaluated the UF-100 by comparing performance in urine sediment testing with counting chamber, standardized method, and traditional manual microscopy widely used in laboratories, and established reference ranges in our hospital. METHODS: Urine samples were obtained from patients in their 20s to 60s who visited hospital for regular check-up between March and April 2007 at Ewha Womans University Mokdong Hospital. We selected randomly a total of 261 samples (male 130, female 131) and evaluated correlations of red blood cell (RBC) and white blood cell (WBC) counts of UF-100 with counting chamber, and manual microscopy. Moreover, we established reference ranges of UF-100 and counting chamber according to CLSI guideline, using 156 urine samples (male 93, female 63) with normal dipstick (strip) test results. RESULTS: The RBC correlation coefficients between UF-100 and counting chamber, UF-100 and manual microscopy, counting chamber and manual microscopy were 0.538, 0.873, and 0.619, respectively. The WBC correlation coefficients between UF-100 and counting chamber, UF-100 and manual microscopy, counting chamber and manual microscopy were 0.992, 0.902, and 0.893, respectively and showed good correlations. The results of UF-100 were higher than counting chamber and manual microscopy. The RBC reference ranges of UF-100 nd counting chamber were 0.5-24.9/microliter (male 0.4-12.2/microliter, female 0.9-38.8/microliter) and 0-4/microliter (male 0-4/microliter, female 0-5/microliter), and the WBC reference ranges of those were 0.9-21.8/microliter (male 0.8-12.6/microliter, female 2.0-23.4/microliter) and 0-7/microliter (male 0-7/microliter, female 0-9/microliter). CONCLUSIONS: The fully automated analyzer UF-100 could be useful to enhance efficiency by labor-saving, turnaround time reduction and improving throughput and to enable standardization. But it is needed for further study including clinical evaluation, because the results and reference ranges between UF-100 and counting chamber or manual microscopy showed considerable differences.

Bilateral Peripheral Infiltrative Keratitis After LASIK

PURPOSE: To present a case of peripheral infiltrative keratitis mimicking infectious keratitis on the flap margin and limbus, which appeared on the first postoperative day after the laser in situ keratomileusis (LASIK). METHODS: A 36-year-old woman who underwent uneventful bilateral simultaneous LASIK developed multiple round infiltrate along the flap margin reaching to limbus from the 11 o'clock to 6 o'clock area in both eyes. RESULTS: The flap was lifted and irrigation was performed with antibiotics. but infiltration seemed to appear again. The infiltrate was more concentrated at the periphery and was extended to the limbus. Direct smear and culture for bacteria and fungus were negative. Topical prednisolone acetate 1% eye drops was added, infiltrative condition was resolved. CONCLUSIONS: LASIK induced peripheral infiltrative keratitis, in which infectious origin was ruled out, is reported.

Predicting the Long-Term Outcome after Subacute Stroke within the Middle Cerebral Artery Territory

BACKGROUND AND PURPOSE: The National Institutes of Health Stroke Scale (NIHSS) score is known to be effective in predicting the likelihood of recovery after stroke. However, the baseline NIHSS score predicts long-term outcomes rather crudely because early changes in stroke scores may influence the stroke outcomes. Therefore, a precise prognostic algorithm or a cutoff point for predicting long-term outcomes based on data from serial NIHSS scores is needed. METHODS: We serially assessed 437 patients with acute symptomatic ischemic stroke within the middle cerebral artery territory who presented with nonlacunar stroke and were followed-up for at least 6 months after symptom onset. The NIHSS score was serially checked at 0, 1, 3, 7, and 14 days after admission. In all patients, the Barthel index (BI) and the modified Rankin Scale (mRS) score were checked, with a poor outcome defined as any of the following endpoints: death, modified mRS score of >3, or BI of <60. RESULTS: A marked neurological improvement or worsening (i.e., a change in the NIHSS score of at least 4) was seen in 13.5% or 5.5% of the patients, respectively, during the first 7 days after admission. About 25% of the 437 patients had poor long-term outcomes. Analysis of receiver operating characteristic curves showed that the NIHSS score at day 7 after admission was better for predicting poor long-term outcomes than was the baseline score (P=0.003). In addition, we analyzed the cutoff point of the 7th-day NIHSS score for predicting a poor outcome at 6 months after symptom onset. An NIHSS score of at least 6 at day 7 after admission predicted poor long-term outcomes with a sensitivity of 84% [95% confidence interval (CI), 76-90%], a specificity of 92% (95% CI, 88-94%), and positive and negative predictive values of 77% and 95%, respectively. A logistic regression analysis revealed that age, diffusion-weighted imaging lesion volume, stroke history, and 7th-day NIHSS score were independently associated with poor outcome. However, no score used in addition to the 7th-day NIHSS score improved the prediction of a poor outcome. CONCLUSIONS: An NIHSS score of at least 6 on day 7 after admission accurately forecasts a poor long-term outcome after stroke. Our data may be helpful in predicting the long-term prognosis as well as in making decisions regarding novel therapeutic applications in subacute-stroke trials.