A Removed Chestnut Thorn after Corneal Incision

PURPOSE: To report the surgical technique to remove a chestnut thorn through a corneal incision. CASE SUMMARY: A 54-year-old female visited our clinic complaining of a sudden foreign body sensation and conjunctival injection in her left eye after picking chestnuts 4 days prior to her visit. Visual acuity of both eyes was 1.0 and the intraocular pressures were within normal limits. Slit lamp examination revealed that a chestnut thorn had deeply penetrated the left corneal stroma and a small number of inflammatory cells were observed in the anterior chamber. There was no corneal defect stained with fluorescein and the Seidel test was negative. A corneal foreign body comprised of a chestnut thorn and its remnants was diagnosed and emergency surgery was performed. A partial corneal incision was made along the foreign body and the exposed foreign body was easily and completely removed. The patient was treated with topical antibiotics after surgery and no complication was observed during a follow-up period of 3 months. CONCLUSIONS: In the case of a corneal foreign body comprised of a chestnut thorn, the foreign body with its remnants were easily removed by performing a partial corneal incision.

Clinical Outcomes of Patients Implanted with Bifocal and Extended Depth of Focus Intraocular Lenses

PURPOSE: To compare the postoperative clinical outcomes after cataract surgery with implantation of bifocal intraocular lenses (IOLs) and extended depth of focus (EDOF) IOLs. METHODS: A total of 60 patients were divided into three groups, and each group included 20 patients of 40 eyes: group A with a +3.25 D bifocal IOL in both eyes, group B with an EDOF IOL in both eyes, and group C with a +3.25 D bifocal in one eye and an EDOF IOL in the other eye. We retrospectively reviewed the patients' medical charts to analyze their binocular uncorrected visual acuities (UCVAs; distant, intermediate, and near) and refraction at postoperative 3 months. RESULTS: The binocular distant UCVAs were 0.04 ± 0.01, 0.05 ± 0.02, and 0.04 ± 0.01 in groups A, B, and C, respectively, and there were no differences between the groups (p > 0.05). The intermediate UCVAs were 0.16 ± 0.01, 0.10 ± 0.01, and 0.10 ± 0.01, respectively, and group A was the lowest (A–B, p = 0.031; A–C, p = 0.018; B–C, p = 1.000). The near UCVAs were 0.05 ± 0.01, 0.24 ± 0.01, and 0.13 ± 0.01, respectively, and there were significant differences between the groups (A–B, p < 0.001, A–C: p = 0.009; B–C, p = 0.003). CONCLUSIONS: There were no significant differences among the three groups in binocular distant UCVA, and groups B and C showed better intermediate UCVAs than group A. Near UCVA was ranked in the order of groups A, C, B.

Efficacy and safety of low-dose tacrolimus for active rheumatoid arthritis with an inadequate response to methotrexate

BACKGROUND/AIMS: To determine the efficacy and safety of low-dose tacrolimus in Korean rheumatoid arthritis (RA) subjects with an inadequate response to methotrexate (MTX). METHODS: This was a multicenter, open-label study conducted at five Korean sites. Fifty-six patients with active RA, despite treatment for ≥ 1 month with a stable, maximally tolerated dosage of oral MTX (median dosage, 15 mg/wk), were enrolled and received 1.5 mg/day of tacrolimus as a single oral dose once per day for 16 weeks while continuing to receive MTX. All other disease-modifying anti-rheumatic drugs were discontinued, whereas stable dosages of nonsteroidal anti-inflammatory drugs and oral corticosteroids (≤ 10 mg/day of prednisone or an equivalent corticosteroid) were allowed. The primary clinical response criterion was the American College of Rheumatology's definition of 20% improvement (ACR20) at the end of treatment. RESULTS: The ACR20 response rate was 42.9% (24 of 56 patients) in patients who had received tacrolimus at least once. The overall ACR50 and ACR70 responses at the end of treatment for all patients were 30.4% and 10.7%, respectively. Throughout the treatment period, 37 patients experienced 71 adverse events (AEs) in total, and four patients left the study because of AEs. In addition, 15 patients in total experienced treatment-related AEs. Throughout the treatment period, two patients were reported to experience two serious AEs, and one patient left the study because of a serious AE. CONCLUSIONS: In patients whose active RA persists despite treatment with MTX, low-dose tacrolimus in combination with MTX appears to be safe and well tolerated, and provides clinical benefit.

Effect of Posterior Subtenon Triamcinolone Injection during Vitrectomy for Idiopathic Epiretinal Membrane

PURPOSE: To evaluate the effect of posterior sub-Tenon triamcinolone acetonide injection combined with vitrectomy for idiopathic epiretinal membrane (ERM). METHODS: This study included 40 eyes of 40 patients who underwent vitrectomy and membrane peeling for idiopathic ERM. Triamcinolone acetonide (40 mg) was injected into the posterior sub-Tenon space following vitrectomy in 20 eyes of the injected group. The other 20 eyes that did not receive the injection were selected as the control group to match preoperative visual acuity and central macular thickness with the injected group. Pre- and postoperative best-corrected visual acuity, central macular thickness, intraocular pressure, and complications were compared between the 2 groups. RESULTS: The average visual acuity in the injected group improved from 0.56 +/- 0.23 (log MAR) at baseline to 0.52 +/- 0.36 at 1 month, 0.44 +/- 0.39 at 3 months, and 0.38 +/- 0.41 at 6 months postoperatively. Central macular thickness decreased from 456.2 +/- 86.2 to 399.0 +/- 60.1 at 1 month, 377.1 +/- 71.5 at 3 months, and 353.1 +/- 57.4 at 6 months postoperatively. In the control group, average visual acuity improved from 0.56 +/- 0.23 at baseline to 0.53 +/- 0.25 at 1 month, 0.41 +/- 0.20 at 3 months, and 0.37 +/- 0.24 at 6 months postoperatively. Central macular thickness decreased from 456.4 +/- 74.8 to 394.9 +/- 63.5 at 1 month, 377.2 +/- 56.8 at 3 months, and 358.0 +/- 57.2 at 6 months postoperatively. Significant differences in visual acuity and central macular thickness were not observed between the 2 groups before surgery and during the follow-up period. Intraocular pressure and complications were similar. CONCLUSIONS: Posterior sub-Tenon injection of triamcinolone acetonide combined with vitrectomy for idiopathic epiretinal membrane did not affect postoperative anatomical and functional outcomes.

A Case of Joubert Syndrome Accompanied with Retinal Abnormality

PURPOSE: Joubert syndrome is a rare disorder which affects the cerebellum and the brain stem. Herein, we report a case of Joubert syndrome accompanied with retinal abnormality. CASE SUMMARY: A 9-year-old female visited our hospital with chief complaints of low vision in both eyes, nystagmus, and lack of gaze movement. The best-corrected visual acuity in her right eye was 20/80 and in the left 20/80 and heterotropia was not observed. She appeared to have incomplete total color blindness on the color vision test. The anterior segment test showed no abnormal findings other than diffuse pigmentation and degeneration of the peripheral retina, vascular attenuation, and pale optic disc in both eyes on fundus examination. The patient showed overall developmental delay and decreased muscle tension, but genetic and congenital metabolic disease tests were normal. The molar tooth sign of the midbrain, defect in the lower part of the cerebellum and dilatation of the fourth ventricle were observed on magnetic resonance imaging. CONCLUSIONS: Appropriate evaluation of retinitis pigmentosa and visual function should be performed in Joubert syndrome patients.

Surgical Outcomes of Idiopathic Epiretinal Membrane with Good Visual Acuity

PURPOSE: To evaluate surgical outcomes of idiopathic epiretinal membrane (ERM) with good visual acuity. METHODS: We evaluated patients who were diagnosed with idiopathic ERM with best corrected visual acuity (BCVA) greater than 20/40 and who were followed-up for 12 months or longer after vitrectomy and membrane removal. BCVA, metamorphopsia, central subfield macular thickness (CSMT), foveal contour, and status of photoreceptor inner/outer segment (IS/OS) junction were retrospectively assessed based on the medical records and optical coherence tomography (OCT) images. RESULTS: Twenty-four eyes were included in the present study. The mean BCVA (log MAR) did not significantly improve from baseline to 12 months after surgery (0.26 +/- 0.06 and 0.25 +/- 0.19, respectively). Six eyes showed improved vision of two or more lines, and six eyes had decreased vision of two or more lines. Metamorphopsia remained in all four eyes with preoperative symptoms until 12 months postoperatively. CSMT decreased significantly from 418 +/- 86 microm at baseline to 343 +/- 45 microm at 12 months (p < 0.01). Among 17 eyes without foveal depression at baseline, 11 eyes recovered a foveal depression at an average of 6.6 months after surgery. IS/OS status at baseline was intact in 19 eyes, attenuated in three eyes, and disrupted in two eyes and did not change significantly at 12 months. CONCLUSIONS: Surgical treatment for idiopathic ERM with good visual acuity resulted in anatomical but not functional improvement. Choosing surgery for idiopathic ERM with good visual acuity should be considered carefully because decreased visual acuity could result in some patients.

Surgical Outcomes of Idiopathic Epiretinal Membrane with Good Visual Acuity

PURPOSE: To evaluate surgical outcomes of idiopathic epiretinal membrane (ERM) with good visual acuity. METHODS: We evaluated patients who were diagnosed with idiopathic ERM with best corrected visual acuity (BCVA) greater than 20/40 and who were followed-up for 12 months or longer after vitrectomy and membrane removal. BCVA, metamorphopsia, central subfield macular thickness (CSMT), foveal contour, and status of photoreceptor inner/outer segment (IS/OS) junction were retrospectively assessed based on the medical records and optical coherence tomography (OCT) images. RESULTS: Twenty-four eyes were included in the present study. The mean BCVA (log MAR) did not significantly improve from baseline to 12 months after surgery (0.26 +/- 0.06 and 0.25 +/- 0.19, respectively). Six eyes showed improved vision of two or more lines, and six eyes had decreased vision of two or more lines. Metamorphopsia remained in all four eyes with preoperative symptoms until 12 months postoperatively. CSMT decreased significantly from 418 +/- 86 microm at baseline to 343 +/- 45 microm at 12 months (p < 0.01). Among 17 eyes without foveal depression at baseline, 11 eyes recovered a foveal depression at an average of 6.6 months after surgery. IS/OS status at baseline was intact in 19 eyes, attenuated in three eyes, and disrupted in two eyes and did not change significantly at 12 months. CONCLUSIONS: Surgical treatment for idiopathic ERM with good visual acuity resulted in anatomical but not functional improvement. Choosing surgery for idiopathic ERM with good visual acuity should be considered carefully because decreased visual acuity could result in some patients.

A Case of the Third Nerve Palsy in a Patient with Orbital Aspergillosis

PURPOSE: To report a case of orbital aspergillosis with third nerve palsy. CASE SUMMARY: A 75-year-old male presented with abrupt onset of visual impairment, extraocular movement limitation, and ptosis. The patient previously experienced rhinolalia and headache and was diagnosed with sinusitis 2 months prior, and was treated with oral antibiotics for 1 week. Orbital magnetic resonance imaging revealed a mass with bone erosion including the nasal cavity, ethmoid bone, and left orbit suggestive of fugal sinusitis. Aspergillus was detected histopathologically in the mass which was removed by endoscopic surgery. Amphotericin B was administered intravenously for 7 days along with voriconazole. There was no recurrence during the follow-up period. Extraocular movement limitations and ptosis were recovered postoperatively. CONCLUSIONS: The present study results indicate that visual impairment and third nerve palsy can develop in a patient with orbital aspergillosis.

A Case of Corrected Residual Refractive Error after Cataract Surgery with the Sulcoflex Piggyback IOL

PURPOSE: To report a case of corrected residual refractive error after cataract surgery with sulcoflex piggyback intraouclar lens (IOL). CASE SUMMARY: A 77-year-old man was diagnosed as having hypermature cataract in the right eye and his corrected visual acuity in the same eye was hand-motion before surgery. Refractive error was +9.0 diopter (D) 6 months after conventional cataract surgery in the right eye. The authors performed additional cataract surgery using a piggyback method inserting a +10.0 D IOL in the ciliary sulcus. Four weeks after surgery, his refractive error was -1.25 D, visual acuity increased to 120/200 and 60/200 (with and without correction, respectively). No complication was observed during follow-up time and the patient was satisfied with his results. CONCLUSIONS: Correction of residual refractive error after cataract surgery with sulcoflex piggyback IOL is safe and effective.

Clinical Outcomes of Secondary Intraocular Lens Implantation in Vitrectomized Aphakic Eyes Due to Ocular Trauma

PURPOSE: To evaluate the clinical outcomes of secondary intraocular lens (IOL) implantation in eyes that underwent pars plana vitrectomy and lens removal due to ocular trauma. METHODS: We retrospectively investigated 40 vitrectomized aphakic eyes that had received secondary IOL from March 2005 to January 2012. Various parameters including pre- and postoperative best corrected visual acuity (BCVA) were reviewed. RESULTS: Incidence was higher in males (n = 35, 89.7%) and highest in the 6th decade of life (n = 13, 33.3%). Mean preoperative refractive error was +9.99 +/- 2.80 D in spherical equivalent, and astigmatism was 1.80 +/- 1.73 D. Mean BCVA (log MAR) was 0.53 +/- 0.51 preoperatively and 0.54 +/- 0.46 at 6 months postoperatively. Postoperative refractive error was -1.28 +/- 1.40 D and the astigmatism was 2.54 +/- 1.52 D. The difference between the target and postoperative refractive error was a myopic shift of -0.63 +/- 1.44 D. Postoperative BCVA had no significant correlation with preoperative factors other than preoperative BCVA (p < 0.001). The most common complication was temporarily increased IOP in 4 eyes. Choroidal detachment, recurrence of retinal detachment, bullous keratopathy, and cystoid macular edema were each found in 1 eye. IOL dislocation was corrected with reoperation in 2 eyes. CONCLUSIONS: Secondary IOL implantation can be performed safely in vitrectomized aphakic eyes due to ocular trauma and can be recommended in patients with good preoperative BCVA. Myopic shift of the postoperative refractive error should be considered when calculating IOL power.

A Case of Anti-Cyclic Citrullinated Peptide Antibody-Positive Rheumatoid Arthritis Following Peginterferon Alpha-2A and Ribavirin Therapy for Chronic Hepatitis C / 대한내과학회지

Combination therapy with pegylated interferon (IFN) and ribavirin is the mainstay of treatment for chronic hepatitis C. An important side effect of IFN is the induction of an autoimmune disease such as autoimmune thyroid disease or, rarely, rheumatoid arthritis. However, the introduction of pegylated formulations of IFN can minimize the risk of autoimmune induction by reducing immunogenicity. Detection of anti-cyclic citrullinated peptide (anti-CCP) antibodies can help distinguish rheumatoid arthritis from hepatitis C-related arthritis. Here, we report the first Korean case of a 48-year-old female who developed anti-CCP antibody-positive rheumatoid arthritis following peginterferon alpha-2a therapy for hepatitis C.

TGF-beta-activated kinase-1: New insights into the mechanism of TGF-beta signaling and kidney disease

Transforming growth factor-beta (TGF-beta) is a multifunctional cytokine that regulates a wide variety of cellular functions, including cell growth, cellular differentiation, apoptosis, and wound healing. TGF-beta1, the prototype member of the TGF-beta superfamily, is well established as a central mediator of renal fibrosis. In chronic kidney disease, dysregulation of expression and activation of TGF-beta1 results in the relentless synthesis and accumulation of extracellular matrix proteins that lead to the development of glomerulosclerosis and tubulointerstitial fibrosis, and ultimately to end-stage renal disease. Therefore, specific targeting of the TGF-beta signaling pathway is seemingly an attractive molecular therapeutic strategy in chronic kidney disease. Accumulating evidence demonstrates that the multifunctionality of TGF-beta1 is connected with the complexity of its cell signaling networks. TGF-beta1 signals through the interaction of type I and type II receptors to activate distinct intracellular pathways. Although the Smad signaling pathway is known as a canonical pathway induced by TGF-beta1, and has been the focus of many previous reviews, importantly TGF-beta1 also induces various Smad-independent signaling pathways. In this review, we describe evidence that supports current insights into the mechanism and function of TGF-beta-activated kinase 1 (TAK1), which has emerged as a critical signaling molecule in TGF-beta-induced Smad-independent signaling pathways. We also discuss the functional role of TAK1 in mediating the profibrotic effects of TGF-beta1.

A Case of Pediatric-onset Mixed Connective Tissue Disease Presenting Raynaud's Phenomenon Affecting Tongue, Hands, and Feet

Mixed connective tissue disease (MCTD) was first described by Sharp and coworkers in 1972, characterized by symptoms of Raynaud's phenomenon or swollen hands, overlapping clinical features of systemic lupus erythematosus, systemic sclerosis, or polymyositis/dermatomyositis, and the presence of anti-U1 RNP antibody. MCTD is rare in children and constitutes 0.3~0.6% of all rheumatologic patients in pediatric rheumatology database of the United States. Here, we report the first Korean case of a 10-year-old female patient with MCTD, presenting Raynaud's phenomenon in the hands, feet, and tongue.

Efficacy of Imatinib Mesylate Treatment for a Patient with Rheumatoid Arthritis and Who Developed Chronic Myelogenous Leukemia

Rheumatoid arthritis is associated with an increased risk of hematological malignancy as a result of the RA itself or its treatment. We report here on an unusual case of a 55-year-old female with long-standing rheumatoid arthritis and who was treated with low dose methotrexate and hydrochloroquine. She was diagnosed with chronic myelogenous leukemia that manifested with severe thrombocytosis and basophilia, and this was treated with imatinib mesylate. After 6 months, she achieved a complete cytogenetic response of the CML and a complete resolution of all the RA symptoms without DMARDs.

Annual Report on External Quality Assessment in Clinical Microbiology Laboratory in Korea (2009) / 임상검사와정도관리

Two trials of external quality assessment for clinical microbiology laboratories were performed in 2009. A total of 16 specimens were distributed. Eight specimens were distributed to 339 laboratories with 322 (95.0%) returns in Trial I, and another eight specimens to 337 laboratories with 327 returns (97.0%) in Trial II. Two slide specimens for mycobacterium stain (AFB) were distributed in both Trial I and II. The acceptable percentages of Gram stain were relatively good for both stainability and morphology. The acceptable percentages of bacterial identification (correct answers to species level) on Sterotrophomonas maltophilia, Staphylococcus aureus, Streptococcus agalactiae, Micrococcus luteus, Vibrio parahemolyticus and Candida glabrata (Trial I) were 94.4%, 98.5%, 92.1%, 62.3%, 92.1% and 71.5%, respectively. The acceptable percentages of bacterial identification on Pseudomonas aeruginosa, Enterococcus faecalis, Candida albicans, Staphylococcus epidermidis, Moraxella catarrhalis and Enterobacter cloacae (Trial II) were 98.5%, 94.1%, 89.2%, 86.2%, 79.6% and 98.5%, respectively. The acceptable percentages for antimicrobial susceptibility tests on S. maltophilia and S. aureus (Trial I), and P. aeruginosa and E. faecalis(Trial II) were relatively good compared to data of the last year, except results using disk method for S. maltophilia. The acceptable percentages for AFB stain in Trial I and II were relatively high. In summary, the acceptable percentages of bacterial stain and identification were relatively good. However, it is still necessary that the quality assurance of the individual laboratories should be improved for antimicrobial susceptibility tests, and the selection of the most appropriate antimicrobial agents to test should be also considered.

Effect of Anterior Chamber Depth on Corneal Endothelial Change After Phacoemulsification

PURPOSE: To evaluate the effects of preoperative and postoperative parameters, particularly anterior chamber depth, on corneal endothelial cell loss during cataract surgery. METHODS: Eighty-two eyes of 82 patients who underwent cataract surgery by the same surgeon using the same technique were selected for the present study. Various preoperative and postoperative parameters including age, anterior chamber depth, duration and power of phacoemulsification, preoperative endothelial cell density, coefficient of variation, hexagonality, and grade of nucleosclerosis were evaluated. Endothelial cell densities were recorded preoperatively and at two months postoperatively using a noncontact specular microscope. RESULTS: After two months, the mean central endothelial cell loss in all eyes was 8.77%. Among the pre- and post-operative parameters, patient' age, anterior chamber depth, duration, power, and energy of phacoemulsification and grade of nucleosclerosis showed significant correlation with endothelial cell loss. Stepwise multiple linear regression analysis identified age, nucleosclerosis, anterior chamber depth, and phacoemulsification time as independent predictors for endothelial cell loss. CONCLUSIONS: The risk of endothelial cell loss increased with increases in patient' age, nucleosclerosis, and phacoemulsification time. However, eyes with a deep anterior chamber showed a significantly lower risk of endothelial cell loss.

Comparison of Short Term Clinical Results Between Epi-LASIK and Femtosecond LASIK

PURPOSE: To compare short-term clinical results of femtosecond LASIK with those of epi-LASIK. METHODS: Twenty subjects (40 eyes) underwent femtosecond LASIK and 20 subjects (40 eyes) underwent epi-LASIK for myopia with astigmatism. The results of each surgery were compared with regard to visual acuity, spherical equivalent, safety, efficacy, stability, predictability and high order aberration. RESULTS: Postoperative uncorrected visual acuities were 0.51 +/- 0.11, 0.95 +/- 0.08, and 0.97 +/- 0.08 for epi-LASIK and 0.76 +/- 0.19, 0.97 +/- 0.07, and 0.98 +/- 0.06 for femtosecond LASIK at one week, one month, and two months after surgery, respectively. Femtosecond LASIK showed faster improvement in visual acuity. Postoperative spherical equivalents were -0.83 +/- 0.24, -0.31 +/- 0.19, and -0.27 +/- 0.09 for epi-LASIK and -0.47 +/- 0.21, -0.28 +/- 0.15, and -0.25 +/- 0.12 for femtosecond LASIK. Safety, efficacy, stability, and predictability showed no differences between the two groups. High order aberrations were increased significantly; however, no significant difference between the two groups was found. CONCLUSIONS: Both epi-LASIK and femtosecond LASIK are effective for surgical correction of myopia with fast visual rehabilitation. In addition, epi-LASIK and femtosecond LASIK showed good safeties, efficacies, predictabilities, and stabilities.

IL-15 Induced an Increased SDF-1 Expression in the Synovial Fibroblasts of Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Interleukin-15 (IL-15) recruits and activates synovial T cells, and IL-15 plays an important role in amplifying and perpetuating inflammation in the pathogenesis of rheumatoid arthritis (RA). Stromal cell-derived factor-1 (SDF-1) is a potent chemoattractant for memory T cells in the inflamed RA synovium. This study investigated the effect of IL-15 on SDF-1 production in RA fibroblast-like synoviocytes (FLS). METHODS: The expressions of IL-15 and SDF-1 were determined from the synovium of patients with RA and osteoarthritis (OA) by performing immunohistochemistry. The expressions of SDF-1 was measured from the RA FLS that were cultured with IL-15 and IL-17 by real-time RT-PCR and ELISA. The SDF-1 expression was also measured, via ELISA, from the RA FLS stimulated by IL-15 together with the inhibitors of such intracellular signal molecules as phosphatidylinositol 3-kinase (PI 3-kinase, LY294002), STAT3 (AG490), MAP Kinase (PD98059), NF-kappaB (parthenolide) and activator protein 1 (AP-1, curcumin). RESULTS: IL-15 and SDF-1 were mainly expressed in the RA synovium compared to that of the OA synovium. IL-15 increased the SDF-1 expressions and it, and had an additive effect with IL-17 on the SDF-1 expressions in the cultured RA FLS. The IL-15 induced increase of the SDF-1 expression in the cultured RA FLS was blocked by the inhibitors of PI 3-kinase, NF-kappaB and AP-1. CONCLUSION: The SDF-1 expression was increased in the RA synovium and it was up-regulated by IL-15 in the RA FLS through the PI 3-kinase, NF-kappaB, and AP-1 pathways. These results imply that the IL-15 induced increase of the SDF-1 expressions may be involved in the immunopathogenesis of RA.

IL-15 Induced an Increased SDF-1 Expression in the Synovial Fibroblasts of Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Interleukin-15 (IL-15) recruits and activates synovial T cells, and IL-15 plays an important role in amplifying and perpetuating inflammation in the pathogenesis of rheumatoid arthritis (RA). Stromal cell-derived factor-1 (SDF-1) is a potent chemoattractant for memory T cells in the inflamed RA synovium. This study investigated the effect of IL-15 on SDF-1 production in RA fibroblast-like synoviocytes (FLS). METHODS: The expressions of IL-15 and SDF-1 were determined from the synovium of patients with RA and osteoarthritis (OA) by performing immunohistochemistry. The expressions of SDF-1 was measured from the RA FLS that were cultured with IL-15 and IL-17 by real-time RT-PCR and ELISA. The SDF-1 expression was also measured, via ELISA, from the RA FLS stimulated by IL-15 together with the inhibitors of such intracellular signal molecules as phosphatidylinositol 3-kinase (PI 3-kinase, LY294002), STAT3 (AG490), MAP Kinase (PD98059), NF-kappaB (parthenolide) and activator protein 1 (AP-1, curcumin). RESULTS: IL-15 and SDF-1 were mainly expressed in the RA synovium compared to that of the OA synovium. IL-15 increased the SDF-1 expressions and it, and had an additive effect with IL-17 on the SDF-1 expressions in the cultured RA FLS. The IL-15 induced increase of the SDF-1 expression in the cultured RA FLS was blocked by the inhibitors of PI 3-kinase, NF-kappaB and AP-1. CONCLUSION: The SDF-1 expression was increased in the RA synovium and it was up-regulated by IL-15 in the RA FLS through the PI 3-kinase, NF-kappaB, and AP-1 pathways. These results imply that the IL-15 induced increase of the SDF-1 expressions may be involved in the immunopathogenesis of RA.

Annual Report on External Quality Assessment in Clinical Microbiology Laboratory in Korea (2008) / 임상검사와정도관리

Two trials of external quality assessment for clinical microbiology laboratories were performed in 2008. A total of 16 specimens were distributed. Eight specimens were distributed to 330 laboratories with 319 (96.7%) returns in Trial I, and 8 specimens to 335 laboratories with 319 returns (95.2%) in Trial II. Two slide specimens for mycobacterium stain (AFB) were distributed in Trial I and II. The acceptable percentages of Gram stain were relatively good for both stainability and morphology except for Acinetobacter baumannii. The acceptable percentages of bacterial identification (correct answers to species level) on Klebsiella pneumoniae, Staphylococcus aureus, Neisseria meningitidis, Serratia marcescens, Erysipelothrix rhusiopathiae and Candida albicans (Trial I) were 97.4%, 99.2%, 55.6%, 97.0%, 79.2%, and 92.0%, respectively. The acceptable percentages of bacterial identification on A. baumannii, Enterococcus faecalis, Streptococcus pyogenes, Haemophilus parainfluenzae, Elizabethkingia meningoseptica, and Yersinia pseudotuberculosis (Trial II) were 92.0%, 90.8%, 4.5%, 53.1%, 74.8% and 94.3%, respectively. The acceptable percentages for antimicrobial susceptibility tests on K. pneumoniae and S. aureus (Trial I), and A. baumannii and E. faecalis, (Trial II) were relatively good compared to data of the last year. The acceptable percentages for AFB stain in Trial I and II were relatively high. In summary, the acceptable percentages of bacterial stain and identification were relatively good except some cases with poor specimen quality. However, it is still necessary that the quality assurance of the individual laboratories should be improved for antimicrobial susceptibility tests, and the selection of the most appropriate antimicrobial agents to test should be also considered.