Implication of Porphyromonas gingivalis in colitis and homeostasis of intestinal epithelium / 한국실험동물학회지

Emerging evidences have reported that periodontitis can be a risk factor for the pathogenesis of various systemic diseases. Porphyromonas gingivalis (Pg), one of the crucial pathogens in chronic periodontitis, has been spotlighted as a potential cause for the promotion and acceleration of periodontitis-associated systemic disorders. To investigate the association between Pg and intestinal disease or homeostasis, we treated Pg-derived lipopolysaccharide (LPS) in murine colitis model or intestinal organoid, respectively. Pg-derived LPS (Pg LPS) was administrated into chemically induced murine colitis model and disease symptoms were monitored compared with the infusion of LPS derived from E. coli (Ec LPS). Organoids isolated and cultured from mouse small intestine were treated with Pg or Ec LPS and further analyzed for the generation and composition of organoids. In vivo observations demonstrated that both Pg and Ec LPS exerted slight protective effects against murine colitis. Pg LPS did not affect the generation and growth of intestinal epithelial organoids. Among subtypes of epithelial cells, markers for stem cells, goblet cells or Paneth cells were changed in response to Pg LPS. Taken together, these results indicate that Pg LPS leads to partial improvement in colitis and that its treatment does not significantly affect the self-organization of intestinal organoids but may regulate the epithelial composition.

Clinical and Electrophysiological Changes after Open Carpal Tunnel Release: Preliminary Study of 25 Hands / 대한임상신경생리학회지

BACKGROUND: Electrophysiological study has been known as a useful method to evaluate the therapeutic effect of operation in idiopathic carpal tunnel syndrome (CTS). The purpose of this study was to evaluate the clinical and electrophysiological changes after carpal tunnel release (CTR) compared to the preoperative results. METHODS: We analyzed the changes of nerve conduction study (NCS) before and after minimal open carpal tunnel release in 18 patients (25 hands) with CTS. Follow-up study was performed over 6 months after operation. RESULTS: Clinical improvement was seen in all cases after CTR. In contrast, electrophysiological improvement was various depending on the parameters; the mean median sensory latency and nerve conduction velocity (NCV) improved significantly (p = 0.001). The mean median motor latency also improved, but NCV and compound muscle action potential (CMAP) amplitude did not change. The extent of improvement was evident in moderate CTS, but not in severe CTS. CONCLUSIONS: In this preliminary study, all subjects who underwent CTR achieved a clinical relief along with a significant improvement of electrophysiological parameters such as median sensory latency, sensory NCV and median distal motor latency. After CTR, a number of cases with mild to moderate CTS showed a prominent improvement of clinical and electrophysiological parameters, while fewer improvements were seen in severe CTS, although it did not reach the statistical significance.

Hereditary Spastic Paraplegia with a Novel SPAST Mutation Misdiagnosed with Subacute Combined Degeneration

Autosomal dominant hereditary spastic paraplegia (AD-HSP) is due to mutations in the "spastin" gene (SPAST gene) encoding the AAA protein. The main clinical features of "pure" HSP are progressive lower-limb spasticity with corticospinal tracts and dorsal column degeneration without peripheral neuropathy. Here we report the case of HSP with novel SPAST gene mutation that misdiagnosed with subacute combined degeneration initially. A 58-year-old man with gait disturbance came to our hospital. He was unable to regulate his steps by himself. The impaired gait began 3 years after he had undergone subtotal gastrectomy and chemotherapy for 6 months. Thereafter, he started feeling tingling sensations in the hands and feet and acquired gait difficulties. He denied having a family history of abnormal gait or developmental problem. We diagnosed him with subacute combined degeneration on the evidence of history of gastrectomy, lower normal limit of vitamin B12 (363 pg/ml), apparent absence of vibration sensations and paresthesia in the feet. He was intramuscularly administered cyanocobalamin regularly. However, there was no improvement in his condition. We reconsidered his symptoms and signs, decided to examine the SPAST gene, which is the most common mutation in HSP. The SPAST gene, c.870+1delG, heterozygote, splicing mutation is detected from the gene sample. There was no previous information of this polymorphism or mutation at this locus. We examined his two children, and the same mutation was founded in his son. We report a patient of novel SPAST gene mutation with AD-HSP which is misdiagnosed with SCD.

Hypolipidemia in Patients with Amyotrophic Lateral Sclerosis: A Possible Gender Difference?

BACKGROUND AND PURPOSE: We compared the levels of serum lipid, protein, and glucose between patients with amyotrophic lateral sclerosis (ALS) and healthy controls. METHODS: The serum levels of lipids [including triglycerides, cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL)], protein, and glucose of 95 patients with ALS (60 men) were compared with those of 99 age- and sex-matched healthy controls (64 men). Both groups had normal dietary intakes. RESULTS: Total cholesterol (p=0.004), LDL (p=0.040), triglyceride (p=0.025), and protein (p=0.010) levels, and LDL/HDL ratios (p<0.001) in men with ALS were significantly lower than those in their control counterparts. There were no such significant differences in these parameters between female patients with ALS and female controls. CONCLUSIONS: The serum levels of lipid and protein were significantly lower in male patients with ALS than in the male controls. Since we controlled for the confounding effects of dietary intake, hypolipidemia in ALS might be associated with the pathophysiology of the disease rather than being the result of the decreased dietary intake in ALS patients. Metabolic demand might increase in ALS, and it may be affected by gender.

A Case of Cluster Headache Accompanied by Myoclonus and Hemiparesis

BACKGROUND: Cluster headache is a primary headache disorder characterized by periodic episodes of intense headache accompanied by autonomic symptoms. We report an unusual clinical presentation of cluster headache that was preceded by myoclonus and accompanied by hemiparesis. CASE REPORT: A 26-year-old man visited hospital due to recurrent jerky movements on the left side of his face and neck area lasting 3 days. These jerky movements had disappeared spontaneously without specific treatment. On the 10th day after onset of the jerky movements, the patient developed a series of unilateral severe headaches that were accompanied by autonomic symptoms lasting 1-2 hours. According to the second edition of The International Classification of Headache Disorders, he was diagnosed as having cluster headache. Two of the 16 severe headache attacks this patient suffered were accompanied by dysarthria and hemiparesis. Electroencephalography performed during hemiparesis revealed diffuse lateralized slow activity on the ipsilateral hemisphere of the headache side. The headache and accompanying hemiparesis disappeared after medical treatment for cluster headache. CONCLUSIONS: We describe a case of cluster headache accompanied by hemiparesis, which was preceded by myoclonus. We also outline the possible mechanisms underlying this case.

Neurosyphilis Presenting With Unilateral Tonic Pupil

No abstract available.

Serum S100B Protein as a Marker of Ischemic Stroke Severity During Hyperacute Stage / 대한뇌혈관외과학회지

OBJECTIVE: Elevation of serum S100B protein has been reported after cerebral ischemic strokes. Previous studies had revealed the positive correlation between peak concentration of serum S100B protein and extent of ischemic stroke. However its peak level usually reaches at 48~72 hours from stroke onset time. We evaluate the usefulness of serum S100B protein during hyperacute stage in the patients with ischemic stroke as a marker for expecting clinical severity and prognosis. METHODS: Total 67 patients who arrived in the Emergency Department within 6 hours from ischemic stroke onset were retrospectively recruited. Subjects were grouped according to the level of serum S100B protein (normal vs elevated group). We analyzed the differences of clinical (National Institute of Health Stroke Scale, NIHSS), laboratory (initial serum glucose, initial systolic blood pressure, lipid profiles, homocysteine) and radiologic (visible lesion in the initial MRI) data between those two groups. RESULTS: Mean serum S100B protein was normal in 27 patients and elevated in 40 patients. Infarction sizes, cortical lesions and level of serum triglyceride (TG) were significantly different between two groups. There were no significant differences in the age, sex, stroke etiology, initial NIHSS, initial serum glucose, blood pressure and other lipid profiles. CONCLUSION: Elevated serum S100B protein in the hyperacute phase of ischemic stroke was correlated with infarction extent, cortical involvement and lower serum TG level. Serum S100B protein may be used as an easily assessable and inexpensive marker for predicting infarction size and cortical involvement during hyperacute stage in patients with ischemic stroke regardless of other clinical factors.

Serum S100B Protein as a Marker of Ischemic Stroke Severity During Hyperacute Stage / 대한뇌혈관외과학회지

OBJECTIVE: Elevation of serum S100B protein has been reported after cerebral ischemic strokes. Previous studies had revealed the positive correlation between peak concentration of serum S100B protein and extent of ischemic stroke. However its peak level usually reaches at 48~72 hours from stroke onset time. We evaluate the usefulness of serum S100B protein during hyperacute stage in the patients with ischemic stroke as a marker for expecting clinical severity and prognosis. METHODS: Total 67 patients who arrived in the Emergency Department within 6 hours from ischemic stroke onset were retrospectively recruited. Subjects were grouped according to the level of serum S100B protein (normal vs elevated group). We analyzed the differences of clinical (National Institute of Health Stroke Scale, NIHSS), laboratory (initial serum glucose, initial systolic blood pressure, lipid profiles, homocysteine) and radiologic (visible lesion in the initial MRI) data between those two groups. RESULTS: Mean serum S100B protein was normal in 27 patients and elevated in 40 patients. Infarction sizes, cortical lesions and level of serum triglyceride (TG) were significantly different between two groups. There were no significant differences in the age, sex, stroke etiology, initial NIHSS, initial serum glucose, blood pressure and other lipid profiles. CONCLUSION: Elevated serum S100B protein in the hyperacute phase of ischemic stroke was correlated with infarction extent, cortical involvement and lower serum TG level. Serum S100B protein may be used as an easily assessable and inexpensive marker for predicting infarction size and cortical involvement during hyperacute stage in patients with ischemic stroke regardless of other clinical factors.

Acute Severe Symptomatic Hyponatremia Following Coronary Angiography

Hyponatremia is a relatively common electrolyte disorder. Although severe acute hyponatremia following coronary angiography is rare, potentially lethal neurologic manifestations may result. We describe a patient with severe, symptomatic hyponatremia, an unusual complication of coronary angiography. Lack of familiarity with contrast media-related hyponatremia caused a delay in diagnosis and therapy in our case. The diagnosis of acute hyponatremia should be considered in any patient who develops behavioral or neurologic manifestations following coronary angiography. Prompt diagnosis and treatment is essential to avoid permanent neurologic damage or death.

Unique alterations in penicillin-binding protein 2B of multidrug-resistant Streptococcus pneumoniae from Korea / 감염

BACKGROUND: Pneumococcal resistance became a global issue during the past decades. Korea is reported to be the hottest spot in the world with regard to the prevalence of penicillin and multidrug resistance. Previous molecular epidemiologic studies strongly suggested that antibiotic-resistant pneumococci from Korea are genetically related. To investigate the molecular characteristics of multidrug-resistant (MDR) pneumococcal isolates in Korea, we performed the DNA sequencing of the gene encoding penicillin-binding protein (PBP) 2B. METHODS: A total of 9 invasive MDR strains which were collected from 1990 to 1995 in various parts of Korea and one internationally epidemic Spanish 23F clone were analyzed. The 1.5 kb transpeptidase-encoding region (TER) of PBP 2B gene was amplified and directly sequenced using ABI PRISM Big Dye Terminator cycle sequencing kit (Perkin Elmer). Sequence data were compared with that of a penicillin-susceptible R6 strain. RESULTS: Alterations in nucleotide sequence (5.4-7.8%) and amino acids (3.0-4.3%) of the PBP 2B gene were relatively uniform among 9 Korean MDR strains. Most alterations in nucleotides (86-94%) and amino acids (86-100%) were noted in the hypervariable region between 408 and 993 bp. All 9 strains possessed 14 common alterations in amino acids, among which Asn-276-->Lys, Arg-285-->Cys and Ser-305-->Phe substitutions were unique to Korean MDR strains. CONCLUSION: Sequence analysis of invasive MDR strains showed that a limited number of amino acid substitutions were noted in the wild-type Korean MDR strains in the transpeptidase domain of the PBP 2B gene. Data strongly suggest the possibility of the spread of a few epidemic clones of resistant pneumococci within Korea, which could partly explain the rapid increase of pneumococcal resistance.

PCR Fingerprinting Analysis of Genes Encoding Penicillin-binding Proteins of Multidrug-resistant Streptococcus pneumoniae Isolated from Korea / 감염

BACKGROUND: The rate of pneumococcal resistance in Korea has surged up to the world's highest level in a short period. To investigate the genetic relatedness and the spread of resistant pneumococci within Korea, and to obtain the basic data about structural changes of penicillin-binding proteins(PBPs), we performed a fingerprinting analysis of PBP 1A, 2X, and 2B genes of multidrug-resistant pneumococci isolated in Korea. METHODS: A total of 22 pneumococcal strains isolated from clinical specimens in 2 university-affiliated hospitals during the period from 1989 to 1996 were tested. PBP 1A, 2X, and 2B genes were amplified from chromosomal DNA by the polymerase chain reaction with specific primers. Amplified products were digested with HinfI or MseI and DdeI and were followed by end-labeling with [alpha-32P] dCTP. Direct comparison of fingerprinting patterns between resistant strains and dendrogram analysis which was based on the UPGMA method were carried out. RESULTS: Fingerprinting analysis of PBP 1A, 2X, and 2B genes digested with HinfI showed that 17 out of 22 strains had almost identical patterns. Dendrogram showed that clusters with greater than 90% similarities existed in 77%, 77%, and 82% of strains with PBP 1A, PBP 2X, PBP 2B, respectively. Fingerprinting patterns with MseI and DdeI were the same as those with HinfI. CONCLUSION: Data from PCR fingerprinting analysis of PBP 1A, 2X, 2B genes of multidrug- resistant pneumococci in this study indicate the genetic relatedness between the resistant strains and suggest the possible spread of pneumococcal resistance within Korea.

A Study on Modes of Transmission and Role of Nasal Carriage to Subsequent Infection with Methicillin-Resistant Staphylococcus aureus in Medical ICU Using PFGE / 병원감염관리

BACKGROUND: In Korea, methicillin-resistant Staphylococcus aureus (MRSA) is the most common nosocomial pathogen, which is particularly prevalent in ICU. We performed this study to investigate the modes of transmission of MRSA and the role of nasal carriage of11RSA to subsequent MRSA infections in medical ICU. METHODS: All patients admitted to the medical lCU during 10 months were studied prospectively. Nasal swabs were done in all patients within 24 hours of admission and weekly thereafter. For patients who developed MRSA infections, additional cultures were done before start of antibiotics. Surveillance cultures of nostril, hands of health care workers and environment were done once at the end of the study. Bacterial typing was performed with pulsed-field gel electrophoresis (PFGE) using Smal. RESULTS: Among 138 patients enrolled, 24 patients (17.4 %) were nasal colonizers, and 9 patients (6.5%) were already infected with MRSA prior to admission. New nasal colonization among patients, in whom follow up nasal cultures were done at the interval of 3 days or more, developed at 36.2 % (21/58 patients). New infections of MRSA in patients who were admitted for more than 3 days, developed at 11.7 % (13/111 patients). Patients in isolation room were infected with MRSA less frequently (P <0.05). No other risk factors for nasal colonization of MRSA or MRSA infections were found. There were no significant differences between nasal colonizers and non-colonizers in the incidence of MRSA infections. PFGE analysis of MRSA isolates from patients showed several major patterns, which were similar in both MRSA isolates obtained prior to admission and those acquired after admission. PFGE patterns of MRSA isolates from health care workers and environment were different from those of patients. CONCLUSION: Patients who were infected or colonized with MRSA seemed to be a major source for transmission of MRSA in medical ICU. In medical lCU, where MRSA were prevalent, nasal colonization was not related to the increased incidence of MRSA infections.

Genetic Relatedness of Methicillin-Resistant Staphylococcus aureus Isolates Recovered from 3 Different Hospitals in Korea / 감염

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has become a major pathogen of nosocomial infection. In Korea, incidence of MRSA is alarmingly high up to 70-80% of total S. aureus strains isolated from tertiary care hospitals. To investigate the mechanism of intra- and inter-hospital spread of MRSA, we evaluated the genetic relatedness of MRSA isolates recovered from 3 different hospitals in Korea. METHODS:30 MRSA isolates obtained from Samsung Medical Center(SMC), 37 MRSA isolates from Seoul National University Hospital (SNUH) and 40 MRSA isolates from Dankook University Hospital (DUH) were classified into clonal types on the basis of pulsed field gel electrophoresis(PFGE). RESULTS: Several PFGE patterns were predominant among the isolates from SMC(A-7/30[23.3%], B-6/30[20.0%], C-4/30[13.3%], G-3/30[10.0%]). The prevalent PFGE patterns were different between medical ICU(A-3/5[60.0%]) and newborn ICU(B-4/9[44.4%]). The major clone at SNUH was PFGE type A, which was identical with one of the dominant clones of SMC. The major clone at DUH was PFGE type B, which was identical with another dominant clone of SMC. Although MRSA strains from SMC, which caused clinical diseases belonged to major PFGE patterns more often than colonized strains, the association was not significant statistically. CONCLUSION: The presence of epidemic strains of MRSA suggests that epidemic MRSA clones may be originated from common sources and spread between different hospitals. Also, there may be virulence factors of stains or host factors, which could select specific strains.

Ribotyping of Multidrug-resistant Streptococcus pneumoniae from Korea and Other Countries / 감염

BACKGROUND: Recent data from Korea showed that penicillin-resistance in pneumococci was more than 70% with 35% of multidrug-resistance (MDR) among invasive isolates. One of the most important reasons for the rapid increase of pneumococcal resistance in Korea would be the spread of resistance. Previous data of pulsed-field gel electrophoresis (PFGE) and penicillin-binding protein profile suggested the spread of pneumococcal resistance. To investigate the genetic relatedness of multidrug-resistant strains, we performed the ribotyping with resistant strains isolated from different countries. METHODS: A total of 42 pneumococcal isolates from Korea(33), Spain(5), and the United States(4), which were resistant to more than 3 classes of antimicrobial agents on agar dilution methods, and a R6 penicillin-susceptible strain were used for ribotyping. Ribotyping was performed with the restriction enzyme Pvu II by using a [alpha- 32P]dCTP-labeled gene probe from Escherichia coil 16S+23S RNA. RESULTS: Ribotype of a R6 strain was quite different form those of resistant strains. A total of 12 different ribotypes were noted in multidrug-resistant strains. Nineteen of 33 Korean strain (57.6%), 3 strains from the United States (75%), and 4 strains form Spain (80%) belonged to ribotype A or A subtypes. Discriminatory index of the ribotyping was 0.83. Ribotyping produced more patterns which could denote more discriminatory power than PFGE. CONCLUSION: The data strongly suggest the genetic relatedness of resistant strains from different countries. It might suggest the spread of pneumococcal resistance within Korea, which could partly explain the rapid increase of resistance in a short period.

In vitro Efficacy of Antibiotic Combinations against Multidrug-resistant Streptococcus pneumoniae / 감염

BACKGROUND: Penicillin- and multidrug-resistant Streptococcus pneumoniae became a global problem during recent decades. Multidrug resistance poses a serious threat to clinical medicine due to restriction of selecting appropriate antimicrobial agents to treat with. Current data suggest that any single antimicrobial agent cannot be a satisfactory option to treat pneumococcal infections caused by multidrug-resistant strains, particularly in meningitis. The aim of the study was to assess in vitro efficacy of several antimicrobial combinations that are commonly used in clinical practice, and to obtain reasonable candidate regimens that can be applied to in vivo model. METHODS: We performed time-kill studies of antimicrobial combinations including penicillin, cefotaxime, vancomycin, gentamicin, imipenem and ampicillin against five multidrug-resistant strains and two penicillin-susceptible strains. Penicillin, cefotaxime and vancomycin were combined with gentamicin, respectively. Cefotaxime plus vancomycin, imipenem plus vancomycin, and cefotaxime plus ampicillin combinations were also tested. Synergy was defined as a >or =100-fold or 2-log decrease in colony count at 24 h by the combination compared with that by the most active single agent. RESULTS: Penicillin plus gentamicin, cefotaxime plus gentamicin, and vancomycin plus cefotaxime combinations were demonstrated to have in vitro synergistic activities against multidrug-resistant strains. CONCLUSION: Three combinations showed in vitro synergism against penicillin- resistant pneumococci. Experimental animal study is warranted to determine the clinical relevance of the in vitro results.