BACKGROUND: Staphylococcus aureus frequently colonizes and infects hospitalized patients. Respiratory infections with Staphylococcus aureus are common in patients with compromised airway defenses. However the mechanisms of S. aureus invasion from colonization to the epithelium are unclear. Cell invasion by S. aureus would require destruction of the extracellular matrix, which is believed to be the result of increased matrix metalloproteinases (MMP) activity. METHODS: In this study, respiratory epithelial cells were infected with S. aureus. After removing the extracellular bacteria by washing, the internalized bacteria in the cells were assessed by counting the colonized forming units (CFUs). The cell adhesion proteins, dysadherin and E-cadherin, were evaluated by Western blotting. The MMPs in the bacterial invasion were evaluated by pretreating the cells with GM6001, a MMP inhibitor. RESULTS: The internalization of S. aureus was found to be both time and dose dependent, and the increase in MMP 2 and 9 activity was also dependent on the incubation time and the initial amount of bacterial inoculation. The invasion of S. aureus was attenuated by GM6001 after 12 hours incubation with a multiply of infection (MOI)=50. The expression of dysadherin, a membrane protein, was increased in a time and dose dependent manner, while the expression of E-cadherin was decreased. CONCLUSION: MMPs may mediate the invasion of S. aureus into epithelial cells.
Bacteria ; Blotting, Western ; Cadherins ; Cell Adhesion ; Colon ; Dipeptides ; Epithelial Cells ; Epithelium ; Extracellular Matrix ; Humans ; Matrix Metalloproteinases ; Membrane Proteins ; Proteins ; Respiratory Tract Infections ; Staphylococcus ; Staphylococcus aureus

PURPOSE: This study was performed to examine the effects of image filter on observer performance by counting the number of holes at each wedge step on a radiographic image. MATERIALS AND METHODS: An aluminum step wedge with 11 steps ranged in thickness from 1.5 mm to 16.5 mm in 1.5 mm increments was fabricated for this study. Each step had 10 notched holes with 1.0 mm diameter on the bottom of the step wedge which were ranged in depths from 0.1 mm to 1.0 mm in 0.1 mm increments. Digital radiographic raw images of the aluminum step wedge were acquired by using CCD intraoral sensor. The images were processed using several types of noise reduction filters and kernel sizes. Three observers counted the number of holes which could be discriminated on each step. The data were analyzed by ANOVA. RESULTS: The number of holes at each step was decreased as the thickness of step was increased. The number of holes at each step on the raw images was significantly higher than that on the processed images. The number of holes was different according to the types and kernel sizes of the image filters. CONCLUSION: The types and kernel sizes of image filters on observer performance were important, therefore, they should be standardized for commercial digital imaging systems.
Aluminum ; Noise ; Radiographic Image Enhancement ; Radiography, Dental ; Task Performance and Analysis

A 22-year-old woman with severe Graves' disease was referred from a local clinic because of her refractory hyperthyroidism. She presented with exophthalmos, diffuse goiter, and tachycardia. She was treated with a maximal dose of methimazole and a beta-blocker for 2 months. However, her thyroid function test (TFT) did not improve. TFT showed a free T4 level of 74.7 ng/dL and a thyroid stimulating hormone (TSH) level of 0.007 µIU/mL. She was then administered cholestyramine (4 g thrice daily), hydrocortisone (300 mg/day) and methimazole (100 mg/day) which prepared the patient for surgery by reducing the free T4 level (4.7 ng/dL). The patient underwent a total thyroidectomy without experiencing thyrotoxic crisis. This case describes the use of cholestyramine for the first time in Korea in treating Graves' disease and provides limited evidence that cholestyramine can be an effective option.
Cholestyramine Resin* ; Exophthalmos ; Female ; Goiter ; Graves Disease* ; Humans ; Hydrocortisone ; Hyperthyroidism ; Korea ; Methimazole ; Tachycardia ; Thyroid Crisis ; Thyroid Function Tests ; Thyroidectomy ; Thyrotoxicosis ; Thyrotropin ; Young Adult

A 22-year-old woman with severe Graves' disease was referred from a local clinic because of her refractory hyperthyroidism. She presented with exophthalmos, diffuse goiter, and tachycardia. She was treated with a maximal dose of methimazole and a beta-blocker for 2 months. However, her thyroid function test (TFT) did not improve. TFT showed a free T4 level of 74.7 ng/dL and a thyroid stimulating hormone (TSH) level of 0.007 µIU/mL. She was then administered cholestyramine (4 g thrice daily), hydrocortisone (300 mg/day) and methimazole (100 mg/day) which prepared the patient for surgery by reducing the free T4 level (4.7 ng/dL). The patient underwent a total thyroidectomy without experiencing thyrotoxic crisis. This case describes the use of cholestyramine for the first time in Korea in treating Graves' disease and provides limited evidence that cholestyramine can be an effective option.
Cholestyramine Resin* ; Exophthalmos ; Female ; Goiter ; Graves Disease* ; Humans ; Hydrocortisone ; Hyperthyroidism ; Korea ; Methimazole ; Tachycardia ; Thyroid Crisis ; Thyroid Function Tests ; Thyroidectomy ; Thyrotoxicosis ; Thyrotropin ; Young Adult

OBJECTIVE: To investigate the correlation among age, disc morphology, positive discography, and prognosis in patients with chronic low back pain. METHODS: A total of 183 intervertebral discs in 72 patients with chronic low back pain were studied. Discography was performed using a pressure-controlled manometric technique. The pain reaction during discography at each level was recorded as follows: no pain, dissimilar pain, similar pain, or concordant pain. Discs with similar or concordant pain were classified as positive. All the examined discs were assessed morphologically using axial computed tomography imaging. The grade of general degeneration and annular disruption of the discs were assessed according to the Dallas discogram description (DDD). Intradiscal injection of steroid was tried for patients with symptomatic disc identified during provocative discography and who did not consent to surgical operation. RESULTS: There was a higher correlation between general degeneration and age, as compared with annular disruption and age. Higher general degeneration and annular disruption grades had higher positive rates of discography. However, annular disruption alone was independently associated with positive discography. Age and grade of general degeneration did not affect the prognosis. CONCLUSION: The grade of general degeneration was associated with age, but it was not correlated with positive discography and prognosis. In addition, high grade of annular disruption correlated with positive discography.
Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Low Back Pain* ; Prognosis* ; Radiography

A factor VII gene -401 G/A polymorphism was identified in a patient with a pulmonary embolism. The patient was a 71-year-old woman who presented with acute-onset dyspnea. A chest CT scan revealed a pulmonary embolism. Despite the administration of low-dose warfarin as anticoagulation therapy, there was an excessively prolonged prothrombin time (PT). The blood tests revealed lower factor VII activity than normal. Full factor VII gene sequencing revealed a G to A substitution at ?401 in the promoter region. There were no other gene sequence anomalies. PCR-based analysis indicated lower factor VII gene expression in the patient than in a control subject. The data suggested the promoter polymorphism to be responsible for the lower transcription level. In conclusion, we encountered a case of Factor VII DNA polymorphism in a patient with a pulmonary embolism showing significantly reduced Factor VII activity.
Aged ; DNA ; Dyspnea ; Factor VII ; Female ; Gene Expression ; Hematologic Tests ; Humans ; Polymorphism, Genetic ; Promoter Regions, Genetic ; Prothrombin Time ; Pulmonary Embolism ; Thorax ; Warfarin

OBJECTIVE: To investigate the intra-rater and inter-rater reliability and usefulness of the Korean version of the Scale for the Assessment and Rating of Ataxia (K-SARA) in ataxic stroke patients. METHODS: The original SARA was translated into Korean, back translated to English, and compared to the original version. Stroke patients (n=60) with ataxia were evaluated using the K-SARA by one physiatrist and one occupational therapist. All subjects were rated twice. We divided the subjects into 5 groups by Functional Ambulation Category (FAC) and 3 groups based on the ataxia subscale of the National Institutes of Health Stroke Scale (NIHSS). The mean K-SARA scores representing each group of FAC and the ataxia subscale of NIHSS were compared. RESULTS: The test-retest correlation coefficient of the K-SARA was 0.997 by the therapist and 1.00 by the physiatrist (p<0.001). The inter-rater correlation coefficient of the K-SARA was 0.985 (p<0.001). The ataxia subscale of NIHSS did not correlate with K-SARA. There was a significant difference in the mean K-SARA score by FAC (p<0.001). CONCLUSION: K-SARA is a reliable and valid measure of ataxia in stroke patients in Korea.
Ataxia* ; Humans ; Korea ; National Institutes of Health (U.S.) ; Rehabilitation ; Stroke* ; Walking

Apraxia of eyelid opening (AEO) is a syndrome characterized by the patient's difficulty in initiating eyelid elevation spontaneously. Most of the reported cases were associated with extrapyramidal diseases. We report a case of AEO presented after traumatic brain injury, not with extrapyramidal diseases, and improved by dopaminergic treatment. A 49-year-old man underwent a traffic accident and was transferred to the emergency room in an unconscious state. Brain computed tomography (CT) revealed a subdural and epidural hemorrhage at right temporal and bilateral frontal lobes, and he received burr-hole trephination. After receiving comprehensive treatment including occupational therapy, cognition and mobility gradually improved, but he could not open his eyes voluntarily. With dopaminergic treatment (levodopa/benserazide 200/50 mg), he started to open his eyes spontaneously, especially when eating and undergoing physical training. This case showed that AEO may occur after brain injury and that dopaminergic treatment is beneficial also in AEO patients without extrapyramidal diseases.
Accidents, Traffic ; Apraxias* ; Brain ; Brain Injuries* ; Cognition ; Eating ; Emergency Service, Hospital ; Eyelids* ; Frontal Lobe ; Hemorrhage ; Humans ; Middle Aged ; Occupational Therapy ; Trephining ; Unconsciousness

PURPOSE: To compare the measurements of central corneal thickness (CCT) obtained using two kinds of spectral domain optical coherence tomography (OCT), Pentacam®, and ultrasound pachymetry (USP). METHODS: CCT was measured by Cirrus OCT®, Spectralis OCT®, Pentacam®, and USP in 32 eyes from 32 subjects without ocular disease of the anterior segment. RESULTS: The average CCT measurements using Cirrus OCT®, Spectralis OCT®, Pentacam®, and USP were 549.2 ± 28.7 µm, 545.2 ± 25.4 µm, 554.0 ± 27.8 µm, and 548.4 ± 27.9 µm respectively. The measurements were significantly highly correlated with each other (Pearson's correlation coefficient r > 0.9, all p-values < 0.001), but were significantly different (p < 0.001). The CCT 95% limits of agreement between Cirrus OCT® and Spectralis OCT®, Cirrus OCT® and Pentacam®, Cirrus OCT® and USP, Spectralis OCT® and Pentacam®, and Spectralis OCT® and USP were 27.70 µm, 26.1 µm, 26.97 µm, 22.91 µm, 35.59 µm, and 32.15 µm, respectively. CONCLUSIONS: The CCT values measured using the four devices were highly correlated with each other, but the measurement using Pentacam® was significantly thicker than that using USP. The measurements of the two kinds of spectral domain OCT were similar to those using USP. Therefore, these differences should be considered in clinical use, and measurements cannot be considered interchangeable.
Corneal Pachymetry* ; Tomography, Optical Coherence* ; Ultrasonography*

A 65-year-old male presented with pain in his right medial calf. An imaging study revealed no acute lesions, and a diagnosis of saphenous neuralgia was made by a nerve conduction study. He received temporary pain relief with saphenous nerve blocks twice in a one-week interval. Pulsed radiofrequency neuromodulation reduced pain to 10% of the maximal pain intensity. At 6 months after the procedure, the pain intensity was not aggravated even without medication. Pulsed radiofrequency neuromodulation of the saphenous nerve may offer an effective and minimally invasive treatment for patients with saphenous neuralgia who are refractory to conservative management.
Aged ; Humans ; Male ; Nerve Block ; Neural Conduction ; Neuralgia