Effect of blood pressure and glycemic control on the plasma cell-free DNA in hemodialysis patients

BACKGROUND: The plasma levels of cell-free DNA (cfDNA) are known to be elevated under inflammatory or apoptotic conditions. Increased cfDNA levels have been reported in hemodialysis (HD) patients. The aim of this study was to investigate the clinical significance of cfDNA in HD patients. METHODS: A total of 95 patients on HD were enrolled. We measured their predialysis cfDNA levels using real-time EIF2C1 gene sequence amplification and analyzed its association with certain clinical parameters. RESULTS: The mean plasma cfDNA level in the HD patients was 3,884 +/- 407 GE/mL, and the mean plasma cfDNA level in the control group was 1,420 +/- 121 GE/mL (P < 0.05). Diabetic patients showed higher plasma cfDNA levels compared with nondiabetic patients (P < 0.01). Patients with cardiovascular complications also showed higher plasma cfDNA levels compared with those without cardiovascular complication (P < 0.05). In univariable analysis, the cfDNA level was associated with 3-month mean systolic blood pressure (SBP), white blood cell, serum albumin, creatinine (Cr), normalized protein catabolic rate in HD patients. In diabetic patients, it was significantly correlated with SBP, hemoglobin A1c, and serum albumin. In multivariate analysis, SBP was the independent determinant for the cfDNA level. In diabetic patients, cfDNA level was independently associated with hemoglobin A1c and SBP. CONCLUSIONS: In patients with HD, cfDNA is elevated in diabetic patients and patients with cardiovascular diseases. Uncontrolled hypertension and poor glycemic control are independent determinants for the elevated cfDNA. Our data suggest that cfDNA might be a marker of vascular injury rather than proinflammatory condition in HD patients.

Seroepidemiologic Analysis of Acute Febrile Illness During 1994-1995 in Korea / 감염

BACKGROUND: The principal acute febrile diseases reported in autumn, Korea, have been hemorrhagic fever with renal syndrome (HFRS), scrub typhus, murine METHODS: To evaluate the seroepidemiologic patterns of acute febrile illness in Korea, sera were collected from 5330 patients from 1994 to 1995, and examined for antibodies against Hantaan virus, Orientia tsutsuga-mushi, Rickettsia typhi, and Borrelia burgdorf eri by indirect immunofluorescent antibody technique(IFA) and by macroscopic agglutination test for Leptosp ira intero-gans. RESULTS: Of 640 seropositive cases against O. tsutsu-gamushi, 60% were female; age group of the seventh decade occupied 30%; 89% were reported during October and November. By IFA test, the seropositive rate of murine typhus was 3.5% (187/5330) with high incidence rate (44%) in the period from October to December, and males in their forties and fifties were mostly affected. Cases seropositive for leptospirosis consisted 1% of 5330 acute febrile illness cases. Of 55 seropositive cases, 71% were male; 71% were in their sixties; 78% occurred during the period from August to October. Hantavirus seropositive rate was 12.2% (649/5330) with a high incidence rate (70%) in the period from October to January and males in the thirties were mostly infected. No seropositive case of Lyme disease was present. CONCLUSION: The above results indicate that hantavirus, O. tsutsugamushi, R. typhi, and L. interogans were the main causative agents of acute febrile diseases during autumn season in Korea.

Sequence and Phylogenetic Analyses of Rubella Viruses Isolated from 1995 through 1996 in Korea / 감염

BACKGROUND: The age group of Rubella virus (RV) infection in most industrialized nations located in temperate climates, has in large part shifted from children to young adults since introducing of the RV vaccine in late 1960's. Interestingly, there were rubella outbreaks from 1995 through 1996 in Korea, and middle and high school students were mostly affected during that time. Although continued cycling of the rubella epidemics, there were no reports about the isolation or genetic information of rubella viruses circulated in Korea. METHOD: To isolate RV circulated in Korea, and determine the phylogenetic relationship between RV strains in Korea and RV isolates from other geographic regions including vaccine strains, we inoculated nasopharyngeal secretion samples from clinically diagnosed rubella patients to Vero E6 cells, and sequenced corresponding region of the 5' E1 encoding genomic regions of RV isolates. RESULT: Seven RV strains isolated from Korea showed 93.6 to 97.8% and 98.3 to 100% sequence homologies in nucleotide and amino acid levels, respectively, compared to RA27/3 vaccine strain. Phylogenetic tree based on 359bp of RV indicated that at least two different groups of RV circulated in Korea during 1995-1996 epidemics. CONCLUSION: Our data suggested that mutant RV strains were possibly not the cause of recent rubella epidemics in Korea.

Seroepidemiologic Analysis and Antigen Detection from Patients with Hemorrhagic Fever with Renal Syndrome / 감염

BACKGROUND: Hantaan (HTN) and Seoul (SEO) viruses, harbored by the striped-field mouse(Apodemus agrarius) and the Norway or common rat (Rattus rattus & Rattus norvegicus), respectively, were known to cause hemorrhagic fever with renal syndrome(HFRS) in Korea. We evaluated the seroepidemiologic patterns of hantaviral infections and detect the hantaviral antigens from patients' sera. METHODS: Total 8,102 HFRS patients' sera were collected from 1994 to 1996, and examined by indirect immunofluorescent antibody technique (IFA), hemagglutination inhibition test (HI), IgM emzyme-linked immunosorbent assay (IgM-ELISA) and nested reverse transcription-polymerase chain reaction(RT-PCR). RESULTS: The seropositive rate against hantaviral antigen was 12.0% (973/8102) with the high incidence rate (68.3%) in the period from October to January, and males in the thirties were mostly affected. HTN viral infections were detected 3.5 and 5.2 times higher than SEO viral infections by HI and RT-PCR, respectively, and patients in the fifties were the mostly affected age-group in SEO viral infections, IgM antibodies were detected in the 717 sera of the 905 IFA positive cases (79.2%), and the antigen detection rate of HTN and SEO viruses was 7.7% (56/724). Interestingly, 40 sera (4.4%), showed higher antibody titers against the Puumala (PUU) virus than those against HTN or SEO viruses. CONCLUSION: The results showed HTN and SEO viruses were the main causative agents of HFRS in Korea, and also suggested the possible presence of PUU-related hantaviral infections.