Disseminated Septic Lesions Caused by Staphylococcus epidermidis Mimicking Cysticercosis Detected on Ultrasonography in a Pediatric Patient with Acute Myeloid Leukemia

Staphylococcus epidermidis is a part of the normal skin flora of humans. However, it can cause serious infections in people exposed to foreign bodies or in immunocompromised patients. A 13-year-old boy was hospitalized with fever and myalgia. Painful nodular lesions were detected on the scalp, arms, and legs. Pancytopenia and blasts were present in the peripheral blood. He was diagnosed with acute myeloid leukemia. Magnetic resonance imaging of the whole body showed multiple peripheral rim-enhancing, cyst-like lesions. Ultrasonography showed echogenic nodules inside the cystic lesions in the intramuscular space of the arms and legs. Therefore, cysticercosis was strongly suggested initially. However, an abscess was confirmed on sono-guided biopsy and S. epidermidis was isolated from a microbial culture of the tissue. We report a case of multiple disseminated lesions caused by S. epidermidis in a leukemia patient, initially mistaken for cysticercosis.

Changes in Cytomegalovirus Seroprevalence in Korea for 21 Years: a Single Center Study

PURPOSE: Cytomegalovirus (CMV) infection is mostly asymptomatic but can be detrimental to certain hosts. We investigated changes of CMV seroprevalence in Koreans before and after the year 2000. METHODS: We reviewed laboratory values of patients who were tested for CMV immunoglobulin G (IgG) at Samsung Medical Center, Seoul, Korea, from January 1995 to December 2015. Changes in seroprevalence were analyzed by gender, age, region, and tested year period (period 1, 1995–2005 vs. period 2, 2006–2015). RESULTS: Overall CMV seropositivity was 94.1% (10,900/11,584). There was no significant difference for CMV seropositivity among the two periods (94.2% vs. 94.1%) (P=0.862). CMV seropositivity in the 11 to 20-year age group in period 2 (78.8%) was significantly lower than that of period 1 (89.9%) (P=0.001). The seropositivity of individuals aged 31–40 years (97.4%) was significantly higher than that of younger age groups (P < 0.001) and lower than that of older age groups (P < 0.001). Of 2,441 females of reproductive age (from 15 to 49), CMV seropositivity was 97% (2,467/2,441). The seropositivity in women aged 20–24-years was higher than that of men in the same age group (97.6% vs. 85.6%, P=0.003). No significant difference was observed among different regions. CONCLUSIONS: Overall CMV seropositivity of Koreans was estimated to be 94% and the average seropositivity of reproductive women was 97%. Monitoring of the changes in seroprevalence including the reproductive age group is needed in the future.

Regulation of vascular smooth muscle phenotype by cross-regulation of krüppel-like factors

Regulation of vascular smooth muscle cell (VSMC) phenotype plays an essential role in many cardiovascular diseases. In the present study, we provide evidence that krüppel-like factor 8 (KLF8) is essential for tumor necrosis factor α (TNFα)-induced phenotypic conversion of VSMC obtained from thoracic aorta from 4-week-old SD rats. Stimulation of the contractile phenotype of VSMCs with TNFα significantly reduced the VSMC marker gene expression and KLF8. The gene expression of KLF8 was blocked by TNFα stimulation in an ERK-dependent manner. The promoter region of KLF8 contained putative Sp1, KLF4, and NFκB binding sites. Myocardin significantly enhanced the promoter activity of KLF4 and KLF8. The ectopic expression of KLF4 strongly enhanced the promoter activity of KLF8. Moreover, silencing of Akt1 significantly attenuated the promoter activity of KLF8; conversely, the overexpression of Akt1 significantly enhanced the promoter activity of KLF8. The promoter activity of SMA, SM22α, and KLF8 was significantly elevated in the contractile phenotype of VSMCs. The ectopic expression of KLF8 markedly enhanced the expression of SMA and SM22α concomitant with morphological changes. The overexpression of KLF8 stimulated the promoter activity of SMA. Stimulation of VSMCs with TNFα enhanced the expression of KLF5, and the promoter activity of KLF5 was markedly suppressed by KLF8 ectopic expression. Finally, the overexpression of KLF5 suppressed the promoter activity of SMA and SM22α, thereby reduced the contractility in response to the stimulation of angiotensin II. These results suggest that cross-regulation of KLF family of transcription factors plays an essential role in the VSMC phenotype.

Regulation of retinal angiogenesis by phospholipase C-β3 signaling pathway

Angiogenesis has an essential role in many pathophysiologies. Here, we show that phospholipase C-β3 (PLC-β3) isoform regulates endothelial cell function and retinal angiogenesis. Silencing of PLC-β3 in human umbilical vein endothelial cells (HUVECs) significantly delayed proliferation, migration and capillary-like tube formation. In addition, mice lacking PLC-β3 showed impaired retinal angiogenesis with delayed endothelial proliferation, reduced endothelial cell activation, abnormal vessel formation and hemorrhage. Finally, tumor formation was significantly reduced in mice lacking PLC-β3 and showed irregular size and shape of blood vessels. These results suggest that regulation of endothelial function by PLC-β3 may contribute to angiogenesis.

Effectiveness of Varicella Zoster Immune Globulin Administration within 96 Hours versus more than 96 Hours after Exposure to the Varicella-Zoster Virus

PURPOSE: Varicella Zoster Immune Globulin (VZIG) is available in Korea for post-exposure prophylaxis of the Varicella-zoster virus (VZV) in high-risk patients. In July 2013, the United States Centers for Disease Control and Prevention (US CDC) recommended extending the time for administration of VariZIG(R) from within 96 hours up to 10 days after VZV exposure. This study was performed to analyze the effectiveness of VZIG prophylaxis between the two groups of patients who received VZIG within 96 hours and more than 96 hours of exposure to varicella. METHODS: A retrospective chart review was performed in pediatric patients who received VZIG at Samsung Medical Center, Seoul, Korea from January 2001 to December 2012. RESULTS: A total of 91 patients were identified. Fifty-seven patients were male (62.6%) and the median age was 5.91 years. Thirty-nine patients (42.9%) were exposed to VZV in the hospital. Underlying diseases were solid tumors (41.8%), hematologic malignancies (40.7%), and others (17.5%). Forty-five patients (49.5%) were hematopoietic cell transplant recipients. Seventy-four patients (81.3%) received VZIG within 96 hours after VZV exposure. There was no significant difference in the development of chickenpox between the two groups (2.7% vs. 5.9%, P=0.4664). In 22 seronegative patients, we also observed no significant difference between the groups in terms of the development of chickenpox (6.6% vs. 0%, P=0.667). CONCLUSIONS: This study showed that the effectiveness of VZIG for the prevention of chickenpox was comparable between patients who received VZIG within 96 hours and those who received VZIG more than 96 hours after exposure to VZV.

General Factors of the Korean Exposure Factors Handbook / 예방의학회지

Risk assessment considers the situations and characteristics of the exposure environment and host. Various physiological variables of the human body reflects the characteristics of the population that can directly influence risk exposure. Therefore, identification of exposure factors based on the Korean population is required for appropriate risk assessment. It is expected that a handbook about general exposure factors will be used by professionals in many fields as well as the risk assessors of the health department. The process of developing the exposure factors handbook for the Korean population will be introduced in this article, with a specific focus on the general exposure factors including life expectancy, body weight, surface area, inhalation rates, amount of water intake, and soil ingestion targeting the Korean population. The researchers used national databases including the Life Table and the 2005 Time Use Survey from the National Statistical Office. The anthropometric study of size in Korea used the resources provided by the Korean Agency for Technology and Standards. In addition, direct measurement and questionnaire surveys of representative samples were performed to calculate the inhalation rate, drinking water intake, and soil ingestion.

Food Ingestion Factors of the Korean Exposure Factors Handbook / 예방의학회지

The purpose of this study was to establish food ingestion factors needed to assess exposure to contaminants through food ingestion. The study reclassified the raw data of the Korean National Health and Nutrition Examination Survey in 2001 into 12 subcategories including grain products, meat products, fish and shellfish, and vegetables for international comparability of exposure evaluation. The criteria for food intake calculation were unified according to the characteristics of food groups, and recommended values for food ingestion factors were calculated through moisture correction and recategorization of cooked, processed, and mixed foods for each group. The average intake rate for grain and grain products was 6.25 g/kg-d per capita and the men's intake rate was approximately 8% higher than that of the women. The average intake rate of meat and meat products was 1.62 g/kg-d per capita and the men's intake rate was 30% higher than that of the women, on average. The average intake rate of fish and shellfish was 1.53 g/kg-d per capita, and the age groups of 1 to 2 and 3 to 6 recorded higher capita intake rates than other age groups, 2.62 g/kg-d and 2.25 g/kg-d, respectively. The average intake rate of vegetables was 6.47 g/kg-d per capita, with the age group of 1 to 2 recording the highest per capita intake rate of 9.79 g/kg-d and that of 13 to 19 recording the lowest mean. The study also offers recommended values for food ingestion factors of other food groups by gender, age, and region. The food ingestion exposure factors will need future updates in consideration of ongoing changes in food consumption behavior.

The Long and Short Incubation Periods of Plasmodium vivax Malaria in Korea: The Characteristics and Relating Factors

BACKGROUND: The cases of Plasmodium vivax malaria in Korea are mixed with long and short incubation periods. This study aims to define clinico-epidemiologic chracteristcs of Plasmodium vivax malaria in Korea. MATERIALS AND METHODS: We selected the civilian cases infected with P. vivax malaria in Korea from the epidemiological investigation data of 2001 to 2010, whose incubation periods could be estimated. The long and short incubation periods were defined by duration of infection and onset time, and the cases were compared by demographic factors and clinical symptom, infection and onset time. The correlation was analyzed between the proportion of cases in the infected region with the long incubation period and meteorological factors along with latitude. RESULTS: The length of the mean short and long incubation periods for the cases were 25.5 days and 329.4 days, respectively. The total number of the study subjects was 897, and the number cases of short and long incubation periods was 575 (64.1%) and 322 (35.9%), respectively. The aspect of incubation period showed a significant difference by region of infection; there was a higher proportion of long incubation period infection cases in Gangwon-do than in Gyeonggi-do and Incheon. The proportion of long incubation period cases showed significant correlation with latitude and temperature of August and September of the infected regions. CONCLUSIONS: Incubation period of P. vivax malaria in Korea showed significant difference by infected region, infection and onset time and the proportion of long incubation period cases showed significant correlation with latitude and meteorological factors of the infected regions.

Non-Adherence to Psychiatric Intervention in Work Related Burns

PURPOSE: Patients with work related burns suffer from anxiety, depression, insomnia and suicide ideation etc. Psychiatric symptoms could be reduced by treatment. Almost all patients are referred to psychiatric intervention in our hospital. However, a number of patients show non-adherence. The aim of this study is to figure out the reason of non-adherence and psychiatric symptoms of work related burns patients. METHODS: 123 patients participated in this study. Startle, Physiological arousal, Anger, and Numbness (SPAN), Feeling Suicide, Patient Health Questionnaire-2 (PHQ-2) were administered as screening tool. Questions about psychiatric intervention and reasons to refuse psychiatric intervention were asked. RESULTS: 32% patients were depressed, 34% patients had suicide ideation and 59% had PTSD after work related burns. However, 46% of burn patients had not been treated. Stigma of psychiatric intervention and concerns about dependency were major reasons for non-adherence. CONCLUSION: There are gap between necessity and reality of psychiatric intervention on work related burn patients.

Characteristics of Summer Heatwave Victims of Emergency Department Visits in Korea During 2011: Results from the Surveillance System of Heat-related Illness Based on Emergency Department

PURPOSE: The aim of this study was to examine characteristics of health-related victims identified through the Surveillance System of Heat-related Illness (SSHI) based on emergency department (ED) visits. METHODS: Between July 1 and September 3 of 2011, 443 heat-related patients were reported by 396 of the 461 EDs participating in the SSHI. Heat-related illness included heat (sun) stroke, heat cramp, heat syncope, and heat exhaustion. A hot day was defined as a day above 30degrees C of daily maximum temperature in locations of provincial and metropolitan government offices. We used chi square test for identification of risk factors associated with Heat-related illness in the workplace and heat-related illness heat (sun) stroke. RESULTS: Heatwave, defined as lasting three or more hot days, occurred three times during this period. The daily average number of heat-related patients reported during the heatwave period was 15.7 per day, more than four times the usual rate. The daily maximum temperature showed positive correlation with occurrence of heat-related illness. Heat exhaustion was the most frequent cause (46.0%), with approximately 70% of all cases occurring between noon and 6 p.m. The number of people suffering from heat-related illness while outdoors was three times greater than that of those who experienced it indoors. Work-related occurrence comprised 56.7% of all cases. All six deaths occurred during the heatwave period and were work-related. CONCLUSION: Working conditions, outdoor activities, and old age may be associated with health-related illnesses. A surveillance system that monitors emergency room visits may be useful in assessment of adverse health effects of summer heatwaves.

Asan Medical Information System for Healthcare Quality Improvement / 대한의료정보학회지

OBJECTIVES: This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. METHODS: Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. RESULTS: AMIS consisted of several distinctive systems: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. CONCLUSIONS: AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed.

Intraeranial Hematoms following Open-heart Surgery - A case report / 대한마취과학회지

Numerous neuropathologic sequelae of cardiopulmonary bypass have been reported. These include embolism, cerebral infarction, neuronal degeneration, subarachnoid hemorrhage and intracranial hemorrhage. These sequelae may account for the neurologic and behavioral desorders in the postoperative period. We report a case of intracranial hematoma following total correction of TOF. An emergency craniotomy was performed to evacuate the hematoma, but the patient failed to regain consciousness following surgery and expired on the 17th postoperative day. In this patient, two factors responsible for the pathogensis of intracranial hemorrhage anre postrulated. First, in the pressence of intraoperative heparin administration, significant hematoma formation may result from damage to the bridging during vein from minor head trauma or alterations in cerebral volume from fluid shift, which may occur during bypass. Second, preexisting arterivenous malformation may be a source of hemorrhage under heparin administration. These hematoma are potentially reversible, so early diagnosis and therapy is extremely improtant.

Adult Respiratory Distress Syndrome Following Trauma - Case report / 대한마취과학회지

Adult respiratory distress syndrome(ARDS) is described under various names in the medical literature: post-traumatic pulmonary insufficiency, wet lung. DaNang lung and shock lung etc., and the syndrome has been used to describe a serious and often fatal conditions which may develop in any patient subjected to severe trauma, major surgery or critical illness. ARDS is characterized by increasing intrapulmonary shunting, increasing work of breathing and decreasing lung compliance. There is still desagreement about exact nature of ARDS as well as its care and revention. In ARDS, the use of positive end-expiratory pressure(PEEP) has been widely debated since its introduction by Ashbaugh and Petty in 1969. Its purpose is to increase the lung volume, especially functional residual capacity at end expiration in order to obtain better alveolar expansion and improved pulmonary gas exchange. This report described two cases of ARDS following trauma, and respiratory care problems were reviewed and discussed.

Clinical Observation of Complications in Spinal Anesthesia / 대한마취과학회지

At present, spinal anesthesia is often recommanded for a safe operation and the management of pain. However the complications from the spinal anesthesia, such as hypotension, dyspnes, nauses and vomiting, pulmonary embolism, headache, auditory and visual disturbances, lumbago, urinary difficulty and neurologic sequelae have often reported from time to time. Thus an attempt to study the complications of spinal anesthesia, particularly the differences of complications between needle sizes(22 gauge and 25 gauge), has been done by our department. The following results were observed: 1) The most common sequelae of spinal anesthesia was hypotension(35.6%) and in order frequency, urinay difficulty(23.3%), headache(16.7%), lumbago(15.3%), nauses of and vomiting(12.8%), dyspnes(8.9%), auditory and visual disturbances(0.83%) and minor neurologic sequelse(0.56%). 2) The incidence of headache and lumbago was more frequent in the 22G, group, but there were no statistically significant differences(p>0.05). 3) The incidence of headache was higher in the females than the males and there were statistically significant differences(p<0.01). 4) The incidence of lumbago was higher in the fourth decade (21.7%), and females showed a higher incidence than in males and there were statistically significant differences(p<0.05). 5) The incidence of lumbago and headache and the degree of headache was without correlation to the number of punctures in both groups(22G group and 26G group). 6) The time to postoperative urination had no correlation to the level of anesthesia.