BACKGROUND: APOE (Apolipoprotein E) has been known as a risk factor for Alzheimer disease. Studies have demonstrated that different APOE E4 phenotypes appear to modulate the effects of cognitive aging in healthy elderly Caucasian populations. APOE E4 allele has different odds ratio risk for Alzheimer disease according to the age of the subject. Previously, we reported the APOE genotype effect on the cognitive function of the elderly populations without dementia. At this time we studied on the APOE E4 genotype combined with age. METHODS: We examined the different effects of APOE E4 allele on the neuropsychological func-tions of 201 community-dwelling Korean elderly individuals without dementia according age. We used the multivariate general linear model analyses. We made a model with the education year, APOE E4 presence, age (same or more than 70-year-old vs. less than 70-year-old) and APOE E4 presence combined with the age. RESULTS: APOE E4 allele did not show the significant effect on the neuropsychological test when ages are not considered. When the APOE E4 allele and age is combined, the recency, delayed recall and cued recall of the Elderly Verbal Learning Test (EVLT) shows a significant result from the multivariate general linear model anlayses. CONCLUSIONS: APOE E4 allele has a different effect on the cognitive function of the elderly popula-tion according to the age.
Aged* ; Aging ; Alleles ; Alzheimer Disease ; Apolipoproteins E* ; Cognition ; Dementia ; Education ; Factor Analysis, Statistical* ; Genotype* ; Humans ; Linear Models ; Neuropsychological Tests ; Odds Ratio ; Phenotype ; Risk Factors ; Verbal Learning

It has become apparent that the MLL (myeloid-lymphoid leukemia or mixed-lineage leukemia) gene is frequently rearranged in patients with secondary leukemias or myelodysplasias associated with chemotherapeutic regimens including topoisomerase II inhibitors (topo II inhibitors). Few studies have been reported on hematological or chromosomal abnormalities associated with topo II inhibitor therapy in Korea. We report three cases with 11q23 abnormalities associated with topo II inhibitor therapy. The first case was a 10-year-old female patient with t(11;16)(q23;p13.3) but without abnor-mal bone marrow findings. The second patient was a 67-year old male with therapy-related myelodys-plastic syndrome (MDS) with add(11)(q23), which evolved into acute myeloid leukemia with t(2;11) (p23;q23) after one year. The other patient was a 42-year-old male with a therapy-related acute myeloid leukemia with rearranged 11q23 demonstrated by fluorescence in situ hybridization (FISH) analysis using an MLL gene probe, which subsequently proved to be t(9;11)(p22;q23) by cytoge-netic analysis. The chemotherapeutic agents for the primary malignancies in the three patients (ovarian primitive neuroectodermal tumor, PNET; lung squamous cell carcinoma; and Ewing's sar-coma/ PNET, respectively) included topo II inhibitiors as well as alkylating agents. The periods from the primary therapy to the identification of 11q23 abnormalities were relatively short; 9 months, 35 months, and 22 months, respectively. Patients treated with topo II inhibitors are at risk for develop-ing secondary MDS and leukemia that have distinct features from those associated with alkylating agents. Although the genetic basis and optimal treatment for the clonal changes induced by topo II inhibitor therapy remain to be determined, a close follow-up with cytogenetic and/or MLL FISH study in patients with a history of topo II inhibitor treatment would be very useful for diagnosis and prediction of secondary hematologic malignancies.
Adult ; Aged ; Alkylating Agents ; Bone Marrow ; Carcinoma, Squamous Cell ; Child ; Chromosome Aberrations* ; Cytogenetics ; Diagnosis ; DNA Topoisomerases, Type II* ; Female ; Fluorescence ; Follow-Up Studies ; Hematologic Neoplasms ; Humans ; In Situ Hybridization ; Korea ; Leukemia ; Leukemia, Myeloid, Acute ; Lung ; Male ; Neuroectodermal Tumors, Primitive ; Topoisomerase II Inhibitors

BACKGROUND: Cell adhesion molecules (CAMs) have been shown to be highly expressed in atherosclerotic lesions. Membrane-bound CAMs allow the tethering and rolling of monocytes and lymphocytes as well as the firm attachment and transendothelial migration of leukocytes. Soluble forms of CAMs may serve as monitors for increased expression of membrane-bound CAMs and thus may reflect progressive formation of atherosclerotic lesions. We assessed the role of the solu-ble CAMs in patients with type 2 Diabetes. METHODS: Serum levels of soluble E-selectin (sE-selectin), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1) were measured by enzyme immunoassay (R and D Systems, Minneapolis, USA) in patients with type 2 Diabetes (n=69) and normal control subjects (n=38). RESULTS: Fasting blood sugar, serum cholesterol, and blood pressure were significantly (P < 0.001) higher in diabetic patients than in control subjects. Serum sE-selectin, sICAM-1, and sVCAM-1 concentrations in diabetic patients were significantly (P < 0.001) higher than in the control subjects (69.7 +/- 32.0, 257.1 +/- 73.0 and 813.8 +/- 322.6 ng/mL versus 43.3 +/- 19.5, 173.1 +/- 66.8, and 400.4 +/- 77.4 ng/mL, respectively). The serum sICAM-1 concentrations in diabetic patients with microalbu-minuria were significantly (P=0.004) higher than in those patients without microalbuminuria (311.3 +/- 79.0 ng/mL versus 245.2 +/- 60.2 ng/mL). However, the sE-selectin and sVCAM-1 concentrations in diabetic patients with microalbuminuria were only slightly (P < 0.10) higher than in the patients without microalbuminuria. CONCLUSIONS: These results suggest that three kinds of circulating CAMs measured in this study increased significantly in patients with type 2 Diabetes. It is considered that circulating CAMs may be markers for atherosclerotic lesions in patients with type 2 Diabetes with symptomatic and asymptomatic atherosclerosis.
Atherosclerosis ; Blood Glucose ; Blood Pressure ; Cell Adhesion Molecules* ; Cell Adhesion* ; Cholesterol ; Diabetes Mellitus, Type 2* ; E-Selectin ; Fasting ; Humans ; Immunoenzyme Techniques ; Intercellular Adhesion Molecule-1 ; Leukocytes ; Lymphocytes ; Monocytes ; Transendothelial and Transepithelial Migration ; Vascular Cell Adhesion Molecule-1

BACKGROUND: Anti-topoisomerase I antibodies (anti-topo-I) have been known to be a specific serologic marker for systemic sclerosis (SSc). However, anti-topo-I have also been detected fre-quently in the sera of patients with diagnosis other than SSc since the enzyme linked immunosor-bent assay (ELISA) has been used widely. In order to clarify the clinical significance of anti-topo-I on ELISA, we analyzed the clinical features of the patients positive for anti-topo-I. METHODS: Anti-topo-I and other antinuclear antibodies (ANA) were investigated by conventional ELISA methods. The clinical characteristics were analyzed in 38 patients positive for anti-topo-I and 28 patients with SLE but negative for anti-topo-I. RESULTS: Of 38 patients positive for anti-topo-I, 15 were SLE and eight SSc. The mean level of anti-topo-I in the patients with SSc was higher than that in the patients with SLE (P=0.015). Of 15 anti-topo-I positive patients with SLE, 14 had one or more other ANAs in their sera whereas only one of eight anti-topo-I positive patients with SSc did (P=0.000). There was no significant difference in clinical characteristics between anti-topo-I positive and negative patients with SLE. The preva-lences of restrictive lung disease in both groups with SLE were significantly lower than that in the anti-topo-I positive patients with SSc (P=0.008). CONCLUSIONS: Anti-topo-I is not exclusively specific for SSc and present in a considerable subset of SLE. As well as the level of anti-topo-I, the coexistence of other ANAs is helpful to discriminate SLE from SSc. The Anti-topo-I detected by ELISA does not seem to be a risk factor for restrictive lung disease in the patients with SLE, unlike those with SSc.
Antibodies* ; Antibodies, Antinuclear ; Diagnosis ; Enzyme-Linked Immunosorbent Assay* ; Humans ; Lung Diseases ; Risk Factors ; Scleroderma, Systemic

BACKGROUND: The prevalence of Hepatitis B virus (HBV) in Korea is still higher than that of devel-oped countries. Recently, the automated chemiluminescent microparticle immunoassay analyzer ARCHITECT i2000 (Abbott Laboratories, Abbott Park, IL USA) was introduced in Korea and we evaluated performance of the tests for serological markers for HBV infection. METHODS: We analyzed precision, agreement, sensitivity, specificity and throughput of the HBs antigen, anti-HBs and anti-HBc as well as linearity and compared with the AxSYM (Abbott Labora-tories, Abbott Park, IL USA) for anti-HBs. Precision, linearity and comparison were performed on the basis of the National Committee for Clinical Laboratory Standards guidelines. Random patients 'sera were used for this study. RESULTS: The coefficients of variations of precision were below 5% for anti-HBs and anti-HBc (total) except for the HBs antigen. The agreements, sensitivities and specificities for serologic mark-ers were more than 90%. The linearity and comparison for anti-HBs were statistically significant (P < 0.001). The throughput of ARCHITECT i2000 was 110 tests/hours and that was 2.8 times faster than that of the AxSYM. CONCLUSIONS: These results suggest that ARCHITECT i2000 can provide rapid and effective results for serologic markers for HBV infection. However, each laboratory should decide the utiliza-tion of this analyzer on the basis of volume of samples, other items tested concurrently, and the inter-face of existing facilities etc.
Hepatitis B virus ; Hepatitis B* ; Hepatitis* ; Humans ; Immunoassay* ; Korea ; Prevalence ; Sensitivity and Specificity

BACKGROUND: Identification of antibodies recognizing extractable nuclear antigens (ENAs) is use-ful in the diagnosis and characterization of a variety of connective tissue diseases. Recently, LG ENA Immunoblot (LGCI, Seoul, Korea) was introduced for detecting various autoantibodies to ENAs simultaneously. Performance of this kit was evaluated in this study. METHODS: Sera from 108 SLE patients and 103 RA patients were tested for the presence of spe-cific autoantibodies to ENAs by LG ENA Immunoblot and DID. Concordance rates in each autoan-tibody were obtained. After discordant results were resolved by EIA (ENA ELISA TEST SYSTEM, Zeus Scientific Inc., NJ, USA) and western blot (ANA Western Blot Immunoassay, IMMCO Diag-nostics Inc., NY, USA), sensitivity and specificity of LG ENA Immunoblot were evaluated. Between-day precision was also tested. RESULTS: Concordance rates in each autoantibody in two methods were as follows: anti-RNP (88.0%, 95/108; 100%, 103/103), anti-Sm (87.0%, 94/108; 97.1%, 100/103), anti-SSA (94.4%, 102/108; 99.0%, 102/103), anti-SSB (97.2%, 105/108; 98.1%, 101/103), anti-Scl70 (99.1%, 107/108; 100%, 103/103) in SLE and RA patients, respectively. Sensitivity and specificity of Immunoblot were 92.0% and 99.6% for anti-RNP, 100% and 99.6% for anti-Sm, 100% and 98.6% for anti-SSA, 90.0% and 98.5% for anti-SSB, and 100% and 100% for anti-Scl70, respectively. Between-day precisions were 100% in all anti-ENA antibodies. CONCLUSIONS: LG ENA Immunoblot showed good concordance rates with the conventional DID method and high sensitivity (>90%) and specificity (>98.5%) in detecting all kinds of anti-ENA autoantibodies. LG Immunoblot has another merit in that it can detect several autoantibodies simul-taneously. It is suggested that LG ENA Immunoblot can replace DID for anti-ENA detection without any problem.
Antibodies ; Antigens, Nuclear* ; Autoantibodies* ; Blotting, Western ; Connective Tissue Diseases ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoassay ; Sensitivity and Specificity ; Seoul

Enterococcus gallinarum carrying both vanA and vanC1 genes were detected from a surveillance culture from a patient staying at the surgical intensive care unit for a few years. E. gallinarum, SI04, was highly resistant to vancomycin (MIC of >or=256ng/mL) and teicoplanin (MIC of >or=256ng/mL). Multiplex PCR for vanA, vanB, vanC1 and vanC2/3 genes revealed SI04 to be positive for both vanA and vanC1 genes. This finding supports the fact that genotyping is needed to classify vancomycin-resistant enterococci (VRE). This is the first report on VanC VRE accompanying vanA gene in Korea.
Enterococcus* ; Humans ; Critical Care ; Korea ; Multiplex Polymerase Chain Reaction ; Teicoplanin ; Vancomycin

BACKGROUND: V. parahaemolyticus O3:K6 strains responsible for the increase in the number of cases of diarrhea in Southeast Asia since 1995. We performed serotyping of V. parahaemolyticus isolated from different geographic areas in Korea since 1998. METHODS: A total of 45 V. parahaemolyticus strains were isolated from clinical specimens of pa-tients with diarrhea in different geographic areas of Seoul (Hanyang University Hospital, 16 cases), Incheon (Gachon Medical Center, 27 cases) and Gwangju (Chonnam University Hospital, 2 cases) from 1998 to 2000 in Korea. Serovar O3:K6 of V. parahaemolyticus was determined by slide and tube agglutination tests with specific antisera (Seiken, Japan). RESULTS: The twenty-eight (62%) of 45 samples were positive to specific antisera of V. parahae-molyticus O3:K6. The O3:K6 strains were detected 11/16 (69%) in Seoul, 15/27 (56%) in Incheon, and 2/2 (100%) in Gwangju. V. parahaemolyticus O3:K6 was detected 11/16 (69%) in 1998, 12/18 (67%) in 1999, and 5/11 (45%) in 2000, respectively. CONCLUSIONS: We report the epidemic emergence of V. parahaemolyticus O3:K6 in Korea, since 1998.
Agglutination Tests ; Asia, Southeastern ; Diarrhea ; Gwangju ; Immune Sera ; Incheon ; Korea* ; Seoul ; Serotyping ; Vibrio parahaemolyticus* ; Vibrio*

BACKGROUND: Because extended-spectrum -lactamase (ESBL) producing strains can frequent-ly cause therapeutic failure and infectious outbreaks in hospitals, rapid and accurate detection of these strains are important. We compared the Vitek ESBL test with the NCCLS ESBL phenotypic confirmatory test by disk diffusion (NCCLS ESBL test) and double disk synergy test (DDST). METHODS: For a total of 316 clinical isolates composed of Escherichia coli (184), Klebsiella pneu-moniae (120) and Klebsiella oxytoca (12), we performed the Vitek ESBL test and the NCCLS ESBL test. For sixty-eight ESBL producing isolates, the Vitek ESBL test was compared with the NCCLS ESBL test and the DDST. The ESBL producer was defined as an organism showing an increase in the inhibited zone diameter of >or=5 mm for either cefotaxime or ceftazidime in combination with clavu-lanic acid versus its single test. The DDST was performed with 20 mm and 30 mm for interdisk diam-eter. For seven false negative isolates in the Vitek ESBL test, the DDST of cefepime was performed. RESULTS: Compared with the NCCLS ESBL test, the Vitek ESBL test showed one false positive (specificity, 99.6%), seven false negatives (sensitivity, 89.7%) and 97.5% agreement. Seven false negative isolates of the Vitek ESBL test were the cefoxitin-resistant ESBL producer. In positivity for the NCCLS ESBL test of 68 ESBL producing isolates, cefotaxime-clavulanic acid and ceftazidime-clavulanic acid were 94% and 91%. Cefotaxime, ceftazidime, aztreonam and ceftriaxone showed 95/90%, 100/55%, 100/85% and 95/80% positivity in double-disk synergy with amoxicillin-clavulanic acid (AMC) for 20/30 mm of the interdisk diameter respectively. For seven false negative isolates of the Vitek ESBL test, cefepime showed a distinct synergic effect with AMC. CONCLUSIONS: The Vitek ESBL test may be a useful method for clinical laboratories due to its easy, rapid and sensitive method but its method was less sensitive to cefoxitin-resistant ESBL. For these cases, if the NCCLS ESBL test or DDST with cefepime are added, the detection rate of the ESBL pro-ducer can be augmented.
Amoxicillin-Potassium Clavulanate Combination ; Aztreonam ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Diffusion ; Disease Outbreaks ; Escherichia coli* ; Escherichia* ; Klebsiella oxytoca ; Klebsiella*

BACKGROUND: Recently, we noticed an increased isolation rate for Candida tropicalis from urine of the patients in the intensive care unit (ICU) of the neurosurgery department in our hospital. We inves-tigated the risk factors for funguria and performed randomly amplified polymorphic DNA (RAPD) analysis for the isolates. METHODS: A total of 27 strains including 12 strains of C. tropicalis from the urine of ICU patients collected during a one-month period, 13 strains from other wards than ICU, and 2 control strains were analyzed. RAPD analysis was performed using 2 primers (UBC78 and CD16S). Medical re-cords of the patients were reviewed to determine the risk factors for funguria by C. tropicalis. RESULTS: RAPD analysis showed an identical pattern for all strains of C. tropicalis from ICU patients and a heterogeneous pattern for the isolates from other wards. C. tropicalis funguria of these ICU patients was significantly associated with the use of an urinary catheter (100%, P < 0.001), previous surgery (44%, P < 0.05) and trachostomy (40%, P < 0.05), when compared with those of non-ICU patients. CONCLUSIONS: The identical RAPD pattern of all C. tropicalis strains from ICU patients indicates that they possibly originated from one clone. Through the investigation of risk factors, we can postulate that an urinary catheter might be a source for the outbreaks of urinary tract infections in the ICU. In addition, RAPD analysis might be a very useful test as one of the molecular epidemiologic tools for C. tropicalis funguria.
Candida tropicalis* ; Candida* ; Clone Cells ; Disease Outbreaks ; DNA* ; Epidemiologic Studies* ; Humans ; Intensive Care Units ; Neurosurgery ; Risk Factors* ; Urinary Catheters ; Urinary Tract Infections* ; Urinary Tract*