Simultaneous Detection of Clostridioides difficile Glutamate Dehydrogenase and Toxin A/B: Comparison of the C. DIFF QUIK CHEK COMPLETE and RIDASCREEN Assays

Various commercial assays have recently been developed for detecting glutamate dehydrogenase (GDH) and/or toxin A/B to diagnose Clostridioides difficile infection (CDI). We compared the performance of two assays for the simultaneous detection of C. difficile GDH and toxin A/B, using 150 stool samples: C. DIFF QUIK CHEK COMPLETE (QCC; TechLab, Blacksburg, VA, USA) and RIDASCREEN Clostridium difficile GDH (RC-GDH) and Toxin A/B (RC-Toxin A/B; R-Biopharm, Darmstadt, Germany). For GDH detection, QCC and RC-GDH showed satisfactory sensitivity (95.7% and 94.3%, respectively) and specificity (92.5% and 93.8%, respectively) compared with C. difficile culture. For toxin A/B detection, QCC showed higher sensitivity than RC-Toxin A/B (60.0% vs 33.3%, P < 0.001) compared with toxigenic C. difficile culture. When the results of QCC or RC-GDH+RC-Toxin A/B were used as the first step of a two-step algorithm for diagnosing CDI, QCC permitted more accurate discrimination than RC of positive or negative results for CDI (77.3% and 65.3%, respectively). QCC is useful for the simultaneous detection of C. difficile GDH and toxin A/B as a part of the two-step algorithm for diagnosing CDI.

Sulfuretin Prevents Obesity and Metabolic Diseases in Diet Induced Obese Mice

The global obesity epidemic and associated metabolic diseases require alternative biological targets for new therapeutic strategies. In this study, we show that a phytochemical sulfuretin suppressed adipocyte differentiation of preadipocytes and administration of sulfuretin to high fat diet-fed obese mice prevented obesity and increased insulin sensitivity. These effects were associated with a suppressed expression of inflammatory markers, induced expression of adiponectin, and increased levels of phosphorylated ERK and AKT. To elucidate the molecular mechanism of sulfuretin in adipocytes, we performed microarray analysis and identified activating transcription factor 3 (Atf3) as a sulfuretin-responsive gene. Sulfuretin elevated Atf3 mRNA and protein levels in white adipose tissue and adipocytes. Consistently, deficiency of Atf3 promoted lipid accumulation and the expression of adipocyte markers. Sulfuretin’s but not resveratrol’s anti-adipogenic effects were diminished in Atf3 deficient cells, indicating that Atf3 is an essential factor in the effects of sulfuretin. These results highlight the usefulness of sulfuretin as a new anti-obesity intervention for the prevention of obesity and its associated metabolic diseases.

Is Cross-reactivity with Nontuberculous Mycobacteria a Systematic Problem in the Xpert MTB/RIF Assay? / 결핵및호흡기질환

No abstract available.

A Case of Urinary Tract Infection Caused by the Emerging Uropathogen Actinotignum schaalii

Actinotignum schaalii is an emerging uropathogen; however, routine culture protocols and usual phenotypic methods do not allow for easy detection and identification. Herein, we report the first Korean case of urinary tract infection caused by A. schaalii in a 79-year-old patient with prostate cancer. A gram-positive rod bacterium was isolated from the patient's urine after 2 days of culture and identified as A. schaalii using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and DNA target sequencing.

A Case of Cruoricaptor ignavus Isolated From the Blood of a Patient With Ewing Sarcoma

No abstract available.

Antibiotic Resistance Patterns and Serotypes of Salmonella spp. Isolated at Jeollanam-do in Korea

OBJECTIVES: Few long-term studies have been conducted on the serotype and antibiotic resistance patterns of Salmonella speices (spp.) The aim of this study was to determine the serotypes and antibiotic resistance patterns of Salmonella spp. isolated at Jeollanam-do in Korea from 2004 to 2014. METHODS: A total of 276 Salmonella samples were evaluated. Serotyping was carried out according to the Kauffmann–White scheme. Antibiotic susceptibility was determined using the Vitek II system with an AST-N169 card. RESULTS: A total of 22 different serotypes were identified, and the major serotypes were Salmonella Enteritidis (116 strains, 42.0%) and Salmonella Typhimurium (60 strains, 21.7%). The highest resistance was observed in response to nalidixic acid (43.4%), followed by ampicillin (40.5%) and tetracycline (31.6%). Resistance to nalidixic acid was detected in 81.0% of S. Enteritidis. Multidrug resistance was detected in 43.3% of Salmonella spp. S. Enteritidis and S. Typhimurium presented the highest resistance (98.3%) and multidrug resistance rate (73.3%), respectively. The most highly observed antibiotic resistance pattern among Salmonella spp. in this study was ampicillin-chloramphenicol (14 strains, 5.7%). CONCLUSION: Overall, S. Enteritidis and S. Typhimurium showed higher antibiotic resistance than the other Salmonella serotypes tested in this study. Our study will provide useful information for investigating the sources of Salmonella infections, as well as selecting effective antibiotics for treatment.

Laboratory Identification of Leptotrichia Species Isolated From Bacteremia Patients at a Single Institution

We describe the laboratory identification of Leptotrichia species from clinical isolates collected over a six-year period. Five isolates from blood cultures were identified as Leptotrichia species. Gram stain showed large, fusiform, gram-negative or -variable bacilli. Identification based on biochemical testing was unsuccessful; however, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry proved to be a useful tool for identifying Leptotrichia species to the genus level. Species level identification was successfully achieved by using 16S ribosomal RNA gene sequencing.

First Case of Echinocandin-Resistant Candida albicans in Korea

No abstract available.

Penicillium Species Other Than Talaromyces marneffei Producing Red Pigment from Clinical Specimens: Isolation of Talaromyces albobiverticillius

No abstract available.

Induction of thermogenic adipocytes: molecular targets and thermogenic small molecules

Adipose tissue is a central metabolic organ that controls energy homeostasis of the whole body. White adipose tissue (WAT) stores excess energy in the form of triglycerides, whereas brown adipose tissue (BAT) dissipates energy in the form of heat through mitochondrial uncoupling protein 1 (Ucp1). A newly identified adipose tissue called ‘beige fat’ (BAT-like) is produced through a process called WAT browning. This tissue mainly resides in WAT depots and displays intermediate characteristics of both WAT and BAT. Since the recent discovery of BAT in the human body, along with the identification of molecular targets for BAT activation, stimulating energy expenditure has been considered as a great strategy to treat human obesity and metabolic diseases. Here we summarize recent findings regarding molecular targets and thermogenic small molecules that can stimulate BAT and increase energy expenditure, with an emphasis on possible therapeutic applications in humans.

Distribution and Detection of Severe Fever with Thrombocytopenia Syndrome Virus in Ticks Collected from Jeollanam-do, Korea

Severe fever with thrombocytopenia syndrome (SFTS) is firstly reported in China in 2011. Thereafter it is reported an infectious disease in Japan and Korea. It is caused by bunyavirus, called SFTS virus (SFTSV). The main vector of SFTS is Haemaphysalis longicornis tick. We investigated the distribution and detection of SFTSV in ticks collected from the environment using the dragging method and dry ice fogging method from May to November 2014 in Jeollanam-do, Korea. Sampling was taken from the province Suncheon, Gokseong, Boseong, Goheung where patients have occurred in 2013 and Gurye as control. Among the total 3,048 ticks collected, 3,030 ticks were H. longicornis (99.4%) and 18 were Amblyomma testudinarium. H. longicornis was collected 1,330 ticks in Gokseong, 1,188 ticks in Boseong, 240 ticks in Suncheon, 150 ticks in Goheung and 140 ticks in Gurye. Developmental stages by month of H. longicornis were revealed that nymph (92%) was collected from May to June, adult (30%) and nymph (70%) in July, and 93% of larvae from September to October. These results showed the different dominant stage of ticks according to seasons. However, no SFTSV-specific gene was detected in 3,030 ticks of H. longicornis.

Annual Report on the External Quality Assessment Scheme for Clinical Microbiology in Korea (2015)

Annual proficiency surveys were conducted in March, June, and September in 2015 by the Clinical Microbiology Subcommittee of the Korean Association of External Quality Assessment Service. The program covers the sections of bacteriology, advanced bacteriology and mycology, mycobacteriology, and parasitology. Each trial was composed of three sets of different combinations of five bacteria and yeasts. These sets were distributed among laboratories for Gram staining, culture, identification, and antimicrobial susceptibility tests. Five slides with fixed sputum smears were provided as part of each trial for acid-fast bacilli detection. The survey material distribution was section-based. Two survey materials were provided in each trial, while five specimens for mycobacterial culture and identification, five specimens for anti-tuberculosis susceptibility testing and two Mycobacterium tuberculosis strains for rapid detection of rifampin and isoniazid resistance were distributed in the March and June trials. Five virtual microscopy files for stool parasite examination were availed by registered participants in the June trial. Out of the 334 enrolled laboratories, 328 (98.2%), 328 (98.2%), and 329 (98.5%) submitted responses in trials I, II, and III, respectively. Identification of bacteria, namely, Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Vibrio fluvialis by more than 95% of participants was acceptable. Surveillance cultures for vancomycin-resistant enterococci and carbapenem-resistant Enterobacteriaceae were determined accurately by 75.8%–85.3% and 93.1% of the respondents, respectively. Species-level identification of Candida krusei, Candida lusitanae, and Candida guilliermondii was still low at 79.8%, 55.7%, and 42.7%, respectively. Disk diffusion method revealed an unacceptably high false-positive rate of resistance to glycopeptides in E. faecalis and to trimethoprim-sulfamethoxazole in S. pneumoniae. Advanced bacteriology trials revealed unsatisfactory results for species-level identification of moulds. Mycobacterial culture, identification and susceptibility testing, and molecular detection of rifampin and isoniazid resistance were performed exceedingly well by participants. Hymenolepsis diminuta could not be identified by participants, with a correct answer rate of only 46.5% and ‘no parasite seen’ answer rate of only 31.8% for negative specimens. Species-level identification of Candida and moulds was challenging for clinical microbiology laboratories. Disk diffusion method was found to be problematic in testing the susceptibility of microorganisms to glycopeptides and trimethoprim-sulfamethoxazole. Improvement is required in result interpretation of negative specimens in parasitology.

Are Korean Patients Different from Other Ethnic Groups in Total Knee Arthroplasty?

Most of the implants used for total knee arthroplasty (TKA) in Asian patients have been produced based on anthropometry of Western people. Since anatomic features and life styles are different between Western and Eastern people, there would be ethnic differences in terms of conformity of implants to the patient's anatomy or clinical results after TKA. Therefore, surgeons in Asia are particularly interested in related surgical techniques and implant designs used in TKA for improved clinical results and patient satisfaction. In this review, we investigated the anthropometric differences of Koreans from Westerners. Koreans are of shorter stature, less weight, and smaller skeletal structure and have a higher incidence of constitutional varus alignment of the lower extremity. Moreover, compared to Westerner TKA populations, the proportion of female patients was large and primary osteoarthritis was prevalent in preoperative diagnosis in Korean TKA patients. Culturally, Koreans have life styles that demand high flexion positions of the knee such as squatting, kneeling, and cross-legged sitting. Although there were no notable differences in the complication and revision rates following TKA between Westerners and Koreans, the incidence of postoperative deep vein thrombosis and pulmonary thromboembolism was lower in Koreans than Westerners. We hope that further research on implant designs and more interest in TKA will improve outcomes in Korean patients.

Retraction: Ethanol Mediates Cell Cycle Arrest and Apoptosis in SK-N-SH Neuroblastoma Cells

This article has been retracted following a review by the Editorial Board.

Vagolytic atropine attenuates cerebral vasodilation response during acute orthostatic hypotension / 대한마취과학회지

BACKGROUND: Atropine is an anticholinergic drug which is commonly used in clinical practice. The effect of parasympathetic block with atropine on dynamic cerebrovascular regulation remains unclear. This study was aimed to identify effects of vagolytic atropine on cerebrovascular response during acute orthostatic hypotension in humans. METHODS: Continuous middle cerebral blood flow velocity (CBFV, transcranial Doppler) and arterial blood pressure (ABP, Finometer) were measured during a sit-to-stand procedure in 10 healthy subjects with placebo and vagolytic (10 microg/kg) doses of atropine. Cerebral vascular tone was assessed by cerebrovascular resistance (CVR = ABP / CBFV). Dynamic cerebral autoregulation was also assessed by transfer function analysis of ABP and CBFV. RESULTS: During the standing session, ABP fell to a similar extent in both groups by an average of 23 to 25 mmHg (26% to 29%). CBFV also fell in all subjects but significantly more in vagolytic atropine (-15.0 +/- 7.0 cm/s) compared with placebo (-12.0 +/- 5.8 cm/s, P < 0.05). CVR was decreased significantly in the placebo group during posture change (1.56 +/- 0.44 vs. 1.38 +/- 0.38, P < 0.05), in contrast, lesser decreased in the atropine group (1.60 +/- 0.50 vs. 1.53 +/- 0.42, P = 0.193). Transfer function coherence in the very-low-frequency range was significantly increased in the atropine group during the standing session (0.55 +/- 0.14), compared with the sitting session (0.45 +/- 0.14, P = 0.006). CONCLUSIONS: These data present that vagolytic atropine attenuates cerebral vasodilation response to acute orthostatic hypotension, suggesting the use of atropine may need care in patients with cerebrovascular disease with vagal impairment.

A Detailed Analysis of Alcohol Pharmacokinetics in Healthy Korean Men / 대한법의학회지

To determine blood alcohol concentration (BAC) by extrapolation, an understanding of basal pharmacokinetics is indispensable. Breath alcohol concentration (BrAC) has been used for the determination of body alcohol concentration replaced by BAC in Korea. Therefore, the determination of BAC/BrAC ratio is a key problem in alcohol pharmacokinetics. Among several factors, the ingested dose of alcohol and the allelic variation of mitochondrial aldehyde dehydrogenase 2 (ALDH2) are the most significant factors influencing the pharmacokinetic parameters, particularly in the absorption and elimination phases. This study shows a detailed pharmacokinetic analysis of BAC and BrAC associated with genetic polymorphism including ALDH2 in 42 healthy Korean men. The change in the alcohol dose ingested influenced the maximum concentration (C(max)), the time to reach C(max) (T(max)), the absorption rate constant (K(01)), the area under the concentration-time curve (AUC(last)), and the hourly elimination rate. The conversion of wild-type 487Glu (ALDH2*1) to 487Lys (ALDH2*2) in human ALDH2 resulted in changes in C(max) (ALDH2*1/*1, 0.03+/-0.01 g/dL [+/-standard deviation] vs. ALDH2*1/*2, 0.05+/-0.004 g/dL [P<0.01]), AUC(last) (ALDH2*1/*1, 4.48+/-2.19 g.min/dL vs. ALDH2*1/*2, 7.52+/-1.26 g.min/dL [P<0.05]), and the BAC elimination rate (ALDH2*1/*1, 0.05+/-0.02 g/L/hr vs. ALDH2*1/*2, 0.09+/-0.01 g/L/hr [P<0.05]). Moreover, the comparison of BAC and BrAC by Bland-Altman plot showed good agreement, suggesting that the measurement of BrAC can be a good alternative for the determination of BAC, particularly in the post-absorption phase. These results provide fundamental information about the pharmacokinetics of alcohol and the determination of BAC in forensics.

Matrixplasty for the Treatment of Pincer Nail with Nail Growth Plate Deformity / 대한족부족관절학회지

PURPOSE: The purpose of this study was to introduce the 'Matrixplasty' for the treatment of a severely incurved toenail with growth plate deformity and to report our results treating this disease entity. MATERIALS AND METHODS: Between January 2010 and May 2010, 48 consecutive patients (62 cases) underwent treatment of symptomatic incurved toenails with the 'matrixplasty'. The mean period of time at last follow-up was 14.0+/-1.3months. The recurrence rate and complication rate were evaluated. An American Orthopedic Foot and Ankle Society (AOFAS) forefoot hallux score was assigned and patients were evaluated at pretreatment and the last follow-up meeting. For evaluation of improvement in toenail shape, the center to edge angle of the toenail was measured at pretreatment and last follow-up. RESULTS: All ingrown toenails healed and the nail deformity was corrected within 3 weeks after the procedure. Among the 62 cases, four cases had recurred by the last follow-up. The mean pretreatment AOFAS forefoot hallux score was 73.1+/-12.8, and it improved to 98.7+/-1.1 by the last follow-up (p<0.01). The mean center to edge angle of the toenail improved from 53.3+/-12.9 degrees to 18.2+/-7.4 degrees by the last follow-up (p<0.01). Minor paronychia, which was managed with local wound dressing and oral antibiotics, was identified in eight cases. CONCLUSION: Matrixplasty showed excellent clinical results in the treatment of severe incurved toenail (pincer nail) and this procedure also showed great improvement of the deformed toenail and its growth plate.

The Use of COX-2 Selective Nonsteroidal Anti-inflammatory Drugs for the Treatment of Osteoarthritis

Nonsteroidal anti-inflammatory drugs (NSAIDs), are characterized by their anti-inflammatory, analgesic, and antipyretic activities; they have been widely used for the management of acute pain and chronic inflammation. The mechanism of action of NSAIDs is inhibition of prostaglandin biosynthesis. Inflammatory prostaglandins are primarily derived from COX-2, while the prostaglandins formed by COX-1 have in general a more homeostatic role. Based on their selectivity for COX-1 or COX-2, NSAIDs are classified into non-selective NSAIDs and COX-2 selective NSAIDs. Non-selective NSAIDs and COX-2 selective NSAIDs have similar effects on pain relief and inflammation. One major problem associated with the use of non-selective NSAIDs is their adverse effects on the gastrointestinal tract, caused by inhibition of COX-1. Compared with non-selective NSAIDS, the main advantage of COX-2 selective NSAIDs is reduced gastrointestinal complications. Reviews have suggested that COX-2 selective NSAIDs increase the risk of cardiovascular events; however, cardiovascular risk may vary among the selective NSAIDs. Because of their anti-inflammatory properties, the use of NSAIDs is essential for the relief of pain and the symptoms associated with inflammatory conditions such as active osteoarthritis. When NSAIDs are prescribed, age, additional medication such as aspirin, gastrointestinal and cardiovascular status, and co-morbidity must be taken into account. COX-2 selective NSAIDs have minimal effects on platelet function and thus, can also be used for pre and postoperative pain control in patients with osteoarthritis waiting for the surgery.

Functional Evaluation of High-Flex Total Knee Arthroplasty

PURPOSE: This study analyzed the functional result of High-Flex (HF) total knee arthroplasty (TKA) with focusing on the activities related to the Korean life style, and we identified the suitability of the presently used tools for performing functional evaluation. MATERIALS AND METHODS: We retrospectively analyzed 266 knees that underwent HF-TKAs with using a Scorpio-flex and the follow up period for all the knees was over 1 year. Functional evaluation was performed by questionnaire on activities, including cross-leg sitting, squatting, kneeling, standing from the floor, standing from a chair and ascending and descending stairs. The clinical evaluation included the Knee Society Knee Score (KSKS) & Function Score (KSFS), the WOMAC score and the patient's satisfaction score. The identification of suitable tools for the functional evaluation of high flexion activities was performed by statistical analysis. RESULTS: Deep flexion of the knees averaged 132.6degrees. Cross-leg sitting was possible for 90.6%, squatting for 32.3%, kneeling for 28.0%, standing from the floor for 66.9%, standing from a chair for 99.6%, ascending stairs for 96.2% and descending stairs for 90.6%. The WOMAC score and KSKS well differentiated the groups for the possibility of their activities, but the KSFS and patient's satisfaction did not differentiate between the groups for some activities. CONCLUSION: The functional evaluation after total knee arthroplasty with HF-TKA revealed good results on cross-leg sitting, standing from chair, ascending & descending stairs, but still poor results on squatting and kneeling. For the functional evaluation of HF-TKA, we believe that the WOMAC and KSKS are good evaluation tools. The KSFS and the patient's satisfaction need careful interpretation when using these for high flexion-related functional evaluation due to their lack of ability to differentiate between good and poor results by some activities.

Clinical Results of the Accelerated Rehabilitation Program after Meniscal Repair using the RapidLoc Device / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the clinical results of the accelerated rehabilitation program after performing meniscal repair using the RapidLoc device, and we wanted to investigate the incidence of complications related to using the RapidLoc device together with the accelerated rehabilitation program. MATERIALS AND METHODS: We performed a retrospective review of a consecutive series of meniscal repairs that were done by single surgeon with using the RapidLoc meniscal repair device. An accelerated postoperative rehabilitation program followed, and this was independent of whether anterior cruciate ligament (ACL) surgery was also performed. The Lysholm and IKDC (International Knee Documentation Committee) activity scores, the clinical examination findings and the adverse events were recorded for all the patients. In addition, using Barrett's criteria, a repaired meniscus was considered healed if there was no joint line tenderness, effusion or a negative McMurray's test at the latest follow-up. RESULTS: At follow-up, the mean IKDC activity score was 3.38 (1.75 preoperatively), the Lysholm score was 91.8 (48.7 preoperatively). Clinical success occurred for 30 repairs (93.7%) at the time of the last follow-up. Two patient had tenderness on joint line palpation and intermittent effusion, so theses repair were considered failure according to our criteria. There was no specific complication related to the RapidLoc device. CONCLUSION: Our results show that accelerated rehabilitation program after arthroscopic meniscal repair with using the RapidLoc device provided a high rate of clinical meniscus healing and this appeared to be safe and effective.