Enhancement of antigen-specific humoral immune responses and protein solubility through conjugation of bacterial flagellin, Vibrio vulnificus FlaB, to the N-terminus of porcine epidemic diarrhea virus surface protein antigen S0

Porcine epidemic diarrhea (PED) is a highly contagious enteric swine disease. The large economic impact of PED on the swine industry worldwide has made the development of an effective PED vaccine a necessity. S0, a truncated region of the porcine epidemic diarrhea virus (PEDV) spike protein, has been suggested as a candidate antigen for PED subunit vaccines; however, poor solubility problems when the protein is expressed in Escherichia coli, and the inherent problems of subunit vaccines, such as low immunogenicity, remain. Flagellin has been widely used as a fusion partner to enhance the immunogenicity and solubility of many difficult-to-express proteins; however, the conjugation effect of flagellin varies depending on the target antigen or the position of the fusion placement. Here, we conjugated flagellin, Vibrio vulnificus FlaB, to the N- and C-termini of S0 and evaluated the ability of the fusion to enhance the solubility and immunogenicity of S0. Flagellin conjugation in the presence of the trigger factor chaperone tig greatly improved the solubility of the fusion protein (up to 99%) regardless of its conjugation position. Of importance, flagellin conjugated to the N-terminus of S0 significantly enhanced S0-specific humoral immune responses compared to other recombinant antigens in Balb/c mice. The mechanism of this phenomenon was investigated through in vitro and in vivo studies. These findings provide important information for the development of a novel PED vaccine and flagellin-based immunotherapeutics.

Two Cases of Aspiration Pneumonia after Endoscopic Submucosal Dissection / 대한소화기내시경학회지

The greatest advantage of endoscopic submucosal dissection (ESD) in the stomach is that it can be used to perform en bloc resection of a large gastric neoplasm. However, ESD is more technically difficult and more commonly associated with prolonged procedure time and complications than conventional endoscopic mucosal resection. Until now, only a few reports have considered aspiration pneumonia after ESD, which is rare, but can be fatal. We experienced two cases of aspiration pneumonia after ESD with a gastric neoplasm. One was treated by intensive care with mechanical ventilation, and the other by antibiotics only. Prevention is thought to be important for aspiration pneumonia after ESD; therefore, patients at high risk for aspiration pneumonia are urged to take precautions. We considered various factors contributing to aspiration under endoscopy, such as local pharyngeal anesthesia, procedural time, and bleeding.

A Case of Osteoma of the Tongue in a 68-Year-Old Man / 대한이비인후과학회지

Osteoma of the tongue is a rare entity of unknown origin. Clinically, the majority of the osteoma are described as growth of pedunculated mass on the posterior dorsum of the tongue without symptoms. The mechanism for its formation is unknown, but various theories have been proposed. Surgery is an appropriate treatment and no recurrence after surgery has been reported. We experienced a 68 year old man with undiagnosed osteoma of the tongue, incidentally detected during gastroscopy. We report this case with a review of literature.

A case of mammary-like glands carcinoma of the vulva / 대한내과학회지

Mammary-like glands are poorly recognized structures of normal vulvar skin. Here, we report the first case of primary mammary-like gland adenocarcinoma of the vulva in Korea and discuss the differential diagnosis and treatment of this rare tumor. A 62-year-old woman presented with an itching sensation and palpable mass of the vulva. Abdominal computed tomography showed multiple variable-sized nodules with peripheral rim enhancement in the liver. The pathology of the vulva and liver lesions was consistent with invasive ductal carcinoma of the breast, with positive staining for estrogen receptors, progesterone receptors, HER-2, and GCDFP-15. Ultrasonography and magnetic resonance imaging of the breast were normal. Given the histological findings in conjunction with the absence of a breast lesion, a diagnosis of primary mammary-like gland adenocarcinoma of the vulva was made. She died of pneumonia 7 weeks after the diagnosis.

A case of pylephlebitis with Streptococcus viridans and Bacteroides fragilis bacteremia secondary to diverticulitis / 대한내과학회지

Pylephlebitis, a septic thrombophlebitis of the portal vein or one of its tributaries, is a life-threatening complication of intra-abdominal infection. The causes of pylephlebitis include acute diverticulitis, appendicitis, acute cholecystitis, necrotizing pancreatitis, inflammatory bowel disease, and bowel perforation. Although pylephlebitis is an unusual complication of diverticulitis, its morbidity and mortality remain high. Therefore, early diagnosis and initiation of adequate antibiotic therapy is important for improving the long-term prognosis of patients suffering from this rare disease. We report a case of pylephlebitis with Streptococcus viridans and Bacteroides fragilis bacteremia secondary to diverticulitis with a review of the literature.

A Case of Posttraumatic Pleural Effusion with Peripheral Eosinophilia / 결핵및호흡기질환

Eosinophilic pleural effusions (EPE) are defined as those effusions that contain at least 10% eosinophils, and EPE can be associated with peripheral blood eosinophilia in a variety of systemic diseases. There have been a few cases that have addressed the association of peripheral blood eosinophilia and posttraumatic EPE, and this condition can be misdiagnosed as being the result of other causes due to the delayed presentation. We report here on a case of 47-year-old male who presented with eosinophilic pleural effusion associated with peripheral blood eosinophilia at 2 months after minor chest trauma. We excluded the other possible causes such as consumption of drugs, parasite infection, malignancy, diseases of pulmonary eosinophilic infiltration, autoimmune diseases and pulmonary thromboembolism. We observed his clinical course without specific treatment. Three months later, the pleural effusion completely disappeared and the number of peripheral eosinophils returned to normal.

A case of gas gangrene caused by Streptococcus constellatus / 대한내과학회지

Gas gangrene is usually caused by clostridial species; non-clostridial gas gangrene is infrequently reported. S. constellatus belongs to the Streptococcus milleri group, which are considered part of the normal flora and frequently associated with abscess formation. We report a rare case of spontaneous gas gangrene caused by S. constellatus. An 86-year-old man was admitted with gas gangrene of the left hip. He was treated with surgical debridement of the necrotic tissue, and antibiotic therapy, and had a satisfactory clinical course.

Volatile Sulfur Compounds as a Predictor for Esophagogastroduodenal Mucosal Injury

BACKGROUND/AIMS: Halitosis is a symptom that bothers patients more socially than medically and its pathogenic mechanisms are unclear and treatment armamenterium is limited. Clinicians generally ignored active interventions. Since halitosis is closely associated with volatile sulfur compounds (VSCs), we used a Halimeter and gas chromatography to measure VSCs in patients with Helicobacter-pylori (H. pylori)-associated gastric diseases. METHODS: We categorized 72 patients with H. pylori infection into two groups based on their endoscopic findings: a non-erosive mucosal group (NE, n=24) and an erosive mucosal group (E, n=48). Halitosis was objectively assessed by applying either a Halimeter to breath air or gas chromatography to gastric juice. Simultaneously, the expression of VSC-generating enzyme was measured with reverse-transcriptase PCR using mRNA isolated from biopsy tissues. RESULTS: The levels of VSCs in exhaled breaths or aspirated gastric juices differed significantly between the NE and E groups (p<0.00001), suggesting that VSCs might reflect eroded epithelial damage induced by H. pylori infection. The expressions of cystathionine beta-synthase (CBS) and cystathionine gamma-lyase (CSE) were broadly consistent with the degree of mucosal injury. CONCLUSIONS: Erosive changes in esophagogastroduodenal mucosa were strongly correlated with increased VSC levels, suggesting that halitosis might result from H. pylori-associated erosive lesions.

A Case of Adult Hemorrhagic Varicella with Pneumonia / 감염과화학요법

Chickenpox is a common benign childhood disease caused by varicella-zoster virus, typically associated with fever and a characteristic exanthematous vesicular rash. The clinical manifestations in adults are more severe and more commonly complicated with varicella pneumonia. Hemorrhagic varicella, also called malignant chickenpox, is very rare and potentially fatal. Bleeding can occur in the form of hemorrhages within the rash and surrounding skin or within the mucous membrane. We report a case of hemorrhagic varicella complicated with pneumonia in a immunocompromised host. We emphasize on the successful treatment with continuous acyclovir infusion.

A Case of Spondylodiskitis Caused by Injection Site Infection with Methicillin-Resistant Staphylococcus aureus / 감염과화학요법

Infections of the intervertebral disc and adjacent vertebrae may present with spondylitis, discitis and spondylodiscitis and are hematogenous origin in most cases. Potential sources of hematogenous infection are skin and soft tissue infection, genitourinary tract infection, infective endocarditis, intravenous drug abuse, respiratory tract infection and infected intravenous injection site. We have experienced a case of pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with peripheral injection site infection. He was successfully treated with surgical debridement and antibiotics.

A Case of Adult Hemorrhagic Varicella with Pneumonia / 감염과화학요법

Chickenpox is a common benign childhood disease caused by varicella-zoster virus, typically associated with fever and a characteristic exanthematous vesicular rash. The clinical manifestations in adults are more severe and more commonly complicated with varicella pneumonia. Hemorrhagic varicella, also called malignant chickenpox, is very rare and potentially fatal. Bleeding can occur in the form of hemorrhages within the rash and surrounding skin or within the mucous membrane. We report a case of hemorrhagic varicella complicated with pneumonia in a immunocompromised host. We emphasize on the successful treatment with continuous acyclovir infusion.

A Case of Spondylodiskitis Caused by Injection Site Infection with Methicillin-Resistant Staphylococcus aureus / 감염과화학요법

Infections of the intervertebral disc and adjacent vertebrae may present with spondylitis, discitis and spondylodiscitis and are hematogenous origin in most cases. Potential sources of hematogenous infection are skin and soft tissue infection, genitourinary tract infection, infective endocarditis, intravenous drug abuse, respiratory tract infection and infected intravenous injection site. We have experienced a case of pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with peripheral injection site infection. He was successfully treated with surgical debridement and antibiotics.

A Promotive Effect of Low-Level Laser on Hair Cell Regeneration Following Gentamicin Induced Ototoxicity in Postnatal Organotypic Culture of Rat Utricles / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In normal postnatal mammalian inner ear sensory epithelium, regeneration of hair cells is a very rare event, but there is hair cell regeneration with partial restoration of the vestibular sensory epithelium following ototoxic damage. In this study, the effects of low-level laser on hair cell regeneration following gentamicin exposure in postnatal organotypic culture of rat utricles were investigated. MATERIALS AND METHOD: A long term organotypic culture of 2 to 7 day old rat utricular maculae was established to study aminoglycoside-induced vestibular hair cell renewal. The utricles were exposed to 1 mM of gentamicin for 48 hr and allowed to recover in a culture medium only or in a medium with daily irradiation of low-level laser, whereas the control group was not exposed to gentamicin. Whole-mount utricles were stained with FM1-43, which are known to be an efficient marker, to identify live hair cells in cultured tissues. RESULTS: Loss of hair cells was nearly stopped from 2 days after exposure to gentamicin ; a peak of regeneration was reached after 18 days and sustained for two weeks in the medium with the irradiation of low-level laser. CONCLUSION: These results suggest that low-level laser promotes spontaneous hair cell regeneration following gentamicin damage in utricular explants.

Abnormal Blood Flow Between a Pericardial Mass and Right Atrium Detected by Echocardiography in a Case of a Ruptured Angiosarcoma of the Right Atrium

Spontaneous rupture of a primary cardiac angiosarcoma is a rare condition with a poor prognosis. The authors describe the case of a 48-year-old man with abnormal blood flow from a pericardial mass to the right atrium 3 months after pericardiocentesis. The flow was presumed to have occurred due to rupture of this cardiac angiosarcoma of the right atrial wall and pericardium into the right atrial cavity.

Abnormal Blood Flow Between a Pericardial Mass and Right Atrium Detected by Echocardiography in a Case of a Ruptured Angiosarcoma of the Right Atrium

Spontaneous rupture of a primary cardiac angiosarcoma is a rare condition with a poor prognosis. The authors describe the case of a 48-year-old man with abnormal blood flow from a pericardial mass to the right atrium 3 months after pericardiocentesis. The flow was presumed to have occurred due to rupture of this cardiac angiosarcoma of the right atrial wall and pericardium into the right atrial cavity.

A Case of Submandibullar Sialolithiasis due to Actinomycosis / 대한이비인후과학회지

Actinomycosis is an uncommon disease caused by actinomyces species, which are gram-positive anaerobic bacteria with filamentous appearance. Actinomyces israelii is the most common pathogen resulting in actinomycotic infection. The infection usually presents 3 distinct localizations: cervicofacial, thoracic, abdomino-pelvic. Cervicofacial actinomycosis accounts for about 50% of the cases. The sulfur granule defines the pathognomic pathologic finding of actinomycosis, but it has been reported in only 40% of cases. We report on a case of submandibular sialolithiasis that occurred due to antinomycosis in a 50-year old male patient.

Correlation between Spontaneous Nystagmus and Vestibular Function Test Parameters according to Gender and Age in Vestibular Neuritis

BACKGROUND AND OBJECTIVES: There are caloric test, SCEP, DP in Step velocity and VOR asymmetry in SHA test as parameters for evaluation in unilateral peripheral vestibulopathy in parameter of vestibular function test. The aim of this study is to assess the correlation between these parameters and intensity of spontaneous nystagmus in vestibular neuritis. MATERIALS AND METHOD: We evaluated 75 patients who were diagnosed as vestibular neuritis with 3 degree spontaneous nystagmus at vestibular function test lab from January 2000 to July 2005 in Dankook university hospital. The correlations between direction and intensity of spontaneous nystagmus and monothermal caloric test, SCEP and DP in step velocity, VOR asymmetry (0.01, 0.04, 0.16 Hz) in SHA test were analysed. And correlations according to sex, age were also analysed. RESULTS: The correlation coefficient between intensity of spontaneous nystagmus and monothermal caloric test was 0.60. The correlation coefficient between intensity of spontaneous nystagmus and SCEP was 0.35. The correlation coefficient between intensity of spontaneous nystagmus and Tc DP was 0.36 and it showed no significant correlation. The correlation coefficient between intensity of spontaneous nystagmus and VOR asymmetry (0.01, 0.04, 0.16) was 0.57, 0.46, 0.51, respectively and there was higher correlation in man, age under 60. CONCLUSION: Intensity of spontaneous nystagmus showed close relations to monothermal caloric test, VOR asymmetry of SHA, Tc DP, SCEP DP in sequence. In addition, young male patients tends to be closely related to intensity of spontaneous nystagmus.

Minocycline Protects Vestibular Hair Cells from Neomycin-Induced Ototoxicity by Inhibiting Reactive Oxygen Species Production and Caspase-3 Activity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Aminoglycosides, a commonly used antibiotic agent, destroys the sensory hair cells in the cochlear and vestibular system leading to irreversible hearing loss and balance problem. Minocycline, a second-generation tetracycline antibiotic, has been known to possess anti-apoptotic properties in addition to its antimicrobial action. We hypothesized that minocycline would attenuate aminoglycosides induced vestibulotoxicity in rat utricles. SUBJECTS AND METHOD: Utricular maculae prepared from postnatal day 3-4 rats were treated with neomycin alone or in combination with minocycline. For hair cell count, utricles were stained with phalloidin-FITC. Reactive oxygen species (ROS) was assessed using the fluorescent probe, hydrofluorescent diacetate acetyl ester (H2DCFDA). Caspase-3 activity was also examined using the fluorescent caspase-3 substrate. RESULTS: Neomycin induced dose-dependent loss of utricular hair cells. Minocycline reduced ROS production and caspase-3 activation in neomycin treated utricular hair cells. CONCLUSION: Minocycline has protective effect in neomycin induced ototoxicity in rat utricle by inhibiting ROS production and caspase-3 activity.

A Promotive Effect of Low Level Laser on Hair Cell Viability in Postnatal Organotypic Culture of Rat Utricles

BACKGROUND AND OBJECTIVES: To culture and maintain mammalian hair cells is still a big challenge. In this study, long-term organotypic culture of rat utricular maculae was established to study vestibular hair cell. The effects of low level laser on hair cell viability in postnatal organotypic culture of rat utricles were investigated. MATERIALS AND METHOD: Uticular explants were prepared from postnatal 2 to 7 rats and cultured. To improve hair cell survival, the utricles were irradiated daily with low level laser. Whole-mount utricles were stained with FM1-43 which is known to be an efficient marker to identify live hair cells in cultured tissues. Such cells visualized directly through tissue culture dish with cover glass bottom by Confocal laser scanning microscope at specific time points. RESULTS: The explanted utricular hair cells were cultured for up to 31 days in in vitro culture system. In low level laser irradiation group, utricular hair cells were more survived at 24 DIV and 31 DIV. CONCLUSION: These results suggest that low level laser promotes hair cell viability in utricular explants.

A Promotive Effect of Low Level Laser on Hair Cell Viability in Postnatal Organotypic Culture of Rat Utricles

BACKGROUND AND OBJECTIVES: To culture and maintain mammalian hair cells is still a big challenge. In this study, long-term organotypic culture of rat utricular maculae was established to study vestibular hair cell. The effects of low level laser on hair cell viability in postnatal organotypic culture of rat utricles were investigated. MATERIALS AND METHOD: Uticular explants were prepared from postnatal 2 to 7 rats and cultured. To improve hair cell survival, the utricles were irradiated daily with low level laser. Whole-mount utricles were stained with FM1-43 which is known to be an efficient marker to identify live hair cells in cultured tissues. Such cells visualized directly through tissue culture dish with cover glass bottom by Confocal laser scanning microscope at specific time points. RESULTS: The explanted utricular hair cells were cultured for up to 31 days in in vitro culture system. In low level laser irradiation group, utricular hair cells were more survived at 24 DIV and 31 DIV. CONCLUSION: These results suggest that low level laser promotes hair cell viability in utricular explants.