A Rapid Assessing Method of Drug Susceptibility Using Flow Cytometry for Mycobacterium tuberculosis Isolates Resistant to Isoniazid, Rifampin, and Ethambutol / 결핵및호흡기질환

Background@#The current conventional drug susceptibility test (DST) for Mycobacterium tuberculosis (Mtb) takes several weeks of incubation to obtain results. As a rapid method, molecular DST requires only a few days to get the results but does not fully cover the phenotypic resistance. A new rapid method based on the ability of viable Mtb bacilli to hydrolyze fluorescein diacetate to free fluorescein with detection of fluorescent mycobacteria by flow cytometric analysis, was recently developed. @*Methods@#To evaluate this cytometric method, we tested 39 clinical isolates which were susceptible or resistant to isoniazid (INH) or rifampin (RIF), or ethambutol (EMB) by phenotypic or molecular DST methods and compared the results. @*Results@#The susceptibility was determined by measuring the viability rate of Mtb and all the isolates which were tested with INH, RIF, and EMB showed susceptibility results concordant with those by the phenotypic solid and liquid media methods. The isolates having no mutations in the molecular DST but resistance in the conventional phenotypic DST were also resistant in this cytometric method. These results suggest that the flow cytometric DST method is faster than conventional agar phenotypic DST and may complement the results of molecular DST. @*Conclusion@#In conclusion, the cytometric method could provide quick and more accurate information that would help clinicians to choose more effective drugs.

Tumoral calcinosis and calciphylaxis treated with subtotal parathyroidectomy and sodium thiosulphate / 영남의대학술지

Tumoral calcinosis (TC) is a condition resulting from extensive calcium phosphate precipitation, primarily in the periarticular tissues around major joints. Calciphylaxis is a fatal ischemic vasculopathy mainly affecting dermal blood vessels and subcutaneous fat. This syndrome is rare and predominantly occurs in patients with end-stage renal disease. Here, we report on a rare case involving a patient with TC complicated with calciphylaxis. Our patient was a 31-year-old man undergoing hemodialysis who presented with masses on both shoulders and necrotic cutaneous ulcers, which were associated with secondary hyperparathyroidism, on his lower legs. He underwent subtotal parathyroidectomy, and sodium thiosulfate (STS) was administered for 27 weeks. Twenty months after beginning the STS treatment course, he experienced dramatic relief of his TC and calciphylaxis.

Induction of Donor-Specific Tolerance: Is This Achievable?

No abstract available.

Inherited protein S deficiency due to a novel nonsense mutation in the PROS1 gene in the patient with recurrent vascular access thrombosis: A case report

Vascular access thrombosis is one of the major causes of morbidity in patients maintained on chronic hemodialysis. Thrombophilia has been recognized as a risk factor of vascular access thrombosis. The authors report a case of inherited protein S deficiency associated with vascular access thrombotic events. DNA sequence analysis of the PROS1 gene identified a novel heterozygous nonsense mutation in exon 10 by transition of AAG (lysine) to TAG (stop codon) at codon 473 (c.1417A>T, p.K473X). Results from the study suggest that the inherited protein S deficiency due to a PROS1 gene mutation may cause vascular access thrombosis in hemodialysis patients.

Clinical Parameters to Determine the Optimal Timing of CRRT in Critically Ill Patients with Acute Kidney Injury / 대한신장학회지

PURPOSE: The aim of this study was to evaluate the clinical parameters to determine the optimal time for continuous renal replacement therapy (CRRT) in critically ill patients with severe acute kidney injury (AKI). METHODS: A single center retrospective study was performed using data from 166 AKI patients who received CRRT in intensive care unit (ICU) between October 2007 and January 2010. We compared mortality rate at 90 days after the initiation of CRRT, ICU-free and CRRT-free days between "early CRRT" and "late CRRT" groups stratified by blood urea nitrogen (BUN), serum creatinine, urine output and RIFLE criteria. RESULTS: The 90-day mortality rate was significantly lower in the early group compared with the late group when stratified by median value of BUN at the start of CRRT and mean hourly urine output during 6 h, 12 h, and 24 h before CRRT. In addition, the 90-day mortality rate was also significantly lower in patients who received CRRT in the "injury" stage of RIFLE criteria compared with those in "failure" or "loss" stage. ICU-free and CRRT-free days during the first 28 days were significantly longer in the early group when stratified by median level of BUN. However, in terms of creatinine, ICU-free and CRRT-free days were significantly shorter in the early group compared with the late group. CRRT-free days during the first 28 days were also longer in early group stratified by median value of mean hourly urine output during 6 h, 12 h before CRRT. After adjusting for covariates, 90-day mortality was independently lower in the early group defined by median level of BUN (OR=1.65 (1.10-2.47), p=0.015) and mean hourly urine output during 12h before CRRT (OR=1.56 (1.05-2.33), p=0.027). CONCLUSION: Our data suggest that early CRRT may have a survival benefit in critically ill patients with severe AKI, and BUN and urine output at the initiation of CRRT may be important parameters to determine the optimal time for CRRT.

Operational and Regulatory System Requirements for Pursuing Self-sufficiency in Deceased Donor Organ Transplantation Program in Korea / 대한이식학회지

Since beginning with the first organ transplantation from brain-dead donor in 1979, organ transplantation has been developing continuously in Korea. However, organ shortage still is a serious problem in the field of solid organ transplantation. For this reason, it is necessary to promote deceased donor organ transplantation and achieve self sufficiency. There are two system requirements managing deceased donor organ transplantation; operational and regulatory systems. In operational system, mutual and balanced cooperation between transplantation centers, organ procurement organism (OPO), registration/allocation system and NGOs is one of most important determinants to maximize brain dead donor. Especially, transplantation center and OPO need to improve in their organ donation process through evaluating donation practices and developing critical pathway for each step. In addition, public education program focusing on the hospital staff, the family of deceased donors and students should be enhanced to increase public awareness for organ donation. In regulatory system, national transplantation authority for the transplant coordination among various structures and policy-making on the issue of organ donation is necessary. For this purpose, Korean Network for Organ Sharing (KONOS) has to be improved into professional and authoritative body and establish more expanded national database network system. Further improvement in operational and regulatory systems to activate organ donation could enable to achieve the Asian leadership in the field of transplantation as well as self sufficiency for organ transplantation.

Ectopic ACTH Syndrome and Severe Hypokalemia Associated with Suspicious Pancreatic Malignancy: A Case Report / 대한신장학회지

A 72-year-old woman had a 1-month history of general weakness. Previously, after rectal cancer was treated with a low anterior resection, 12 cycles of adjuvant chemotherapy with 5-fluorouracil plus leucovorin was undergone. Follow-up examination showed no evidence of recurrence. However, she suffered from general weakness attributable to hypokalemia, which was refractory to potassium replacement therapy. After further work-up of the hypokalemia, Cushing's syndrome and ectopic adrenocorticotropic hormone (ACTH) syndrome were diagnosed from the laboratory findings that included a markedly elevated level of 24-hour urine-free cortisol. Several imaging studies revealed masses of the pancreas and other organs, which was more likely to be pancreatic cancer. This case is interesting in that cancerous lesions were identified during work-up of hypokalemia.

Development of an Educational Web Site and e-Learning System for Elementary School Students to Reduce Sugar, Natrium and Fat Intakes / 대한지역사회영양학회지

This study was carried out to reduce children's sugar, natrium and fat intakes and establish their healthy lifestyle. To achieve these goals, we developed an educational web site and an e-learning system. The targets of this web site are children, parents and educators. This site has various information about sugar, natrium and fat, and has special menus for each target: such as the 'Let's study' for children, 'Guides for child's eating' for parents, and 'Educational softwares, Lesson plans/materials, and Textbooks/Teaching guides' for educators. We developed three nutrient characters and applied them to the web site. We provided information in the form of texts, images, flash and sounds. This site has special boards in 'Nutrition cafe' menu to interchange information or their successful stories between the connecters. We developed an e-learning system with two courses. One is for junior elementary students and the other is for senior students. Children can study each nutrient step by step in a course according to their academic ability and concern. Also, they can evaluate their academic achievement in this system, which was uploaded into 'Let's study' in children menu in the web site. Conclusively this web site and e-learning system could contribute to reducing children's sugar, natrium and fat intakes by helping children study them systematically and effectively by on-line system. We expect this e-learning system would be a new nutrition education system to make nutrition education more active.

Cross-resistance Between Rifampicin and Rifabutin and Its Relationship with rpoB Gene Mutations in Clinically Isolated MDR-TB Strains / 결핵및호흡기질환

BACKGROUND: Despite the emerging danger of MDR-TB to human beings, there have only been a limited number of drugs developed to treat MDR-TB since 1970. This study investigated the cross-resistance rate between rifampicin (RFP) and rifabutin (RBU) in order to determine the efficacy of rifabutin in treating MDR-TB. In addition, the results of rifabutin were correlated with the rpoB mutations, which are believed to be markers for MDR-TB and RFP resistance. METHODS: The MICs of RBU were tested against 126 clinical isolates of MDR-TB submitted to the clinical laboratory of National Masan TB Hospital in 2004. Five different concentrations (10-160 microgram/ml) were used for the MICs. The detection of the rpoB mutations was performed using a RFP resistance detection kit with a line probe assay(LiPA), which contains the oligonucleotide probes for 5 wide type and 3 specific mutations (513CCA, 516GTC, and 531TTG). The rpoB mutation was determined by direct sequencing. RESULTS: The rate of cross-resistance between RFP and RBU was 70.5%(74/105) at 20 microgram/ml RBU(ed note: How much RFP?) Most mutations (86.3%) occurred in the 524~534 codons. The His526Gln, His526Leu, Leu533Pro, Gln513Glu, and Leu511Pro mutations(Ed note: Is this correct?) were associated with the susceptibilty to RBU. CONCLUSION: Based on the cross-resistance rate between RFP and RBU, RBU may be used effectively in some MDR-TB patients. Therefore, a conventional drug susceptibility test for RBU and a determination of the critical concentration are needed. However, rpoB gene mutation test may be have limited clinical applications in detecting RBU resistance.

The Effect of Thumb Position on Median-Radial Latency Difference

In diagnosis of carpal tunnel syndrome, there are many techniques with high sensitivity Among them, the median-radial latency difference(MRLD) is one of the most useful technique in screening mild carpal tunnel syndrome w ith high sensitivity, no painful discomfort to patients and no motor artifact. In this study, we examined the effect of the thumb position (radial abduction and adduction) on the MRLD. Because the stimulation sites of the median sensory and superficial radial nerves are different from each other, the free movement of the thumb in this examinations is not avoidable. The results are 1) there is no significant effect of the thumb position on median sensory latency. 2) There is no significant effect of the thumb position on superficial radial latency. 3) There is significant effect of the thumb position on MRLD(P<0.01). Therefore, if we diagnose the mild carpal tunnel syndrome with MRLD, the thumb position must be maintained in neutral position through the examination.