Anaphylaxis to polyethylene glycol (PEG) is rare and mainly occurs with the use of laxatives containing PEG. Recently, an increasing number of PEG allergies have been reported, particularly those related to coronavirus disease 2019 (COVID-19) vaccines. mRNA COVID-19 vaccines, such as the BNT162b2 (Pfizer–BioNTech) and mRNA-1273 (Moderna) vaccines, contain PEG2000 as an excipient and are contraindicated when allergy to a vaccine component exist. We report a 55-year-old woman’s history as a case of successful mRNA COVID-19 vaccination and colonoscopy after oral desensitization to PEG in a patient with PEG allergy who required both COVID-19 vaccination and colon evaluation. Allergy to PEG was diagnosed based on clinical history, skin test results, and basophil histamine release testing. Oral desensitization effectively suppressed histamine release from basophils in response to PEG stimulation, suggesting that oral desensitization using PEG-based laxatives may be an effective treatment option for patients with allergy to the substance.

BACKGROUND: KRAS is one of commonly mutated genetic "drivers" in non-small cell lung cancers (NSCLCs). Recent studies indicate that patients with KRAS-mutated tumors do not benefit from adjuvant chemotherapy, so there is now a focus on targeting KRAS-mutated NSCLCs. A feasible mutation detection method is required in order to accurately test for KRAS status. METHODS: We compared direct Sanger sequencing and the peptide nucleic acid (PNA)-mediated polymerase chain reaction (PCR) clamping method in 134 NSCLCs and explored associations with clinicopathological factors. Next-generation sequencing (NGS) was used to validate the results of discordant cases. To increase the resolution of low-level somatic mutant molecules, PNA-mediated PCR clamping was used for mutant enrichment prior to NGS. RESULTS: Twenty-one (15.7%) cases were found to have the KRAS mutations using direct sequencing, with two additional cases by the PNA-mediated PCR clamping method. The frequencies of KRAS mutant alleles were 2% and 4%, respectively, using conventional NGS, increasing up to 90% and 89%, using mutant-enriched NGS. The KRAS mutation occurs more frequently in the tumors of smokers (p=.012) and in stage IV tumors (p=.032). CONCLUSIONS: Direct sequencing can accurately detect mutations, but, it is not always possible to obtain a tumor sample with sufficient volume. The PNA-mediated PCR clamping can rapidly provide results with sufficient sensitivity.
Alleles ; Carcinoma, Non-Small-Cell Lung* ; Chemotherapy, Adjuvant ; Constriction* ; Humans ; Lung Neoplasms ; Peptide Nucleic Acids ; Polymerase Chain Reaction*

Background: Korean standard series (KSS) have not changed for 20 years. Moreover, the Korea Food and Drug Administration has suspended import licensing of Cosmetic series (ChemotechniqueⓇ). Objective: To analyze trends in the positive rates of allergens in patch test using KSS and present a literature review on the comparison of the results those of European baseline series (EBS) and North American Contact Dermatitis Group (NACDG) screening series. Methods: Epidemiologic findings and the positive rate of KSS allergens were analyzed from patients who visited the Department of Dermatology in Ewha Womans University Mokdong Hospital between 1998 and 2018. Literature reviews were conducted on the comparison of the results with those of the 2015∼2016 NACDG, 2013∼2014 ESSCA, and standard antigens in K-camp. Results: The positive rates of KSS allergens from 126 patients in 2018 were compared with those from 184 patients during 1998 to 2007. The top 3 allergens in the two study periods were common; nickel sulfate, cobalt chloride, and potassium dichromate. Remarkably, the positive rates for balsam of Peru and paraben mix increased from 7.1% to 17.5% and from 2.7% to 7.9%, respectively. As compared with the results of NACDG standard series and EBS, KSS lacked fragrance and cosmetic series of allergens, especially fragrance mix II, methyldibromoglutaronitrile, and methylisothiazolinone, and epoxy series of allergens. Conclusion Our results, especially the increasing trends of balsam of Peru and paraben mix, would be further confirmed in a multicenter study. Additionally, in view of the increase in fragrance and preservative allergens, KSS would need the addition of related allergens.

STUDY DESIGN: This is an in-vitro experiment using rabbit intervertebral disc (IVD) cells and growth factors. OBJECTIVES: We wanted to determine the effect of types I, and II atelocollagen and growth factor gene therapy for matrix regeneration of rabbit IVD cells. SUMMARY OF THE LITERATURE REVIEW: Adenovirus-medicated growth factor gene therapy is efficient for matrix regeneration of the IVD. Atellocollagen has provided a favorable environment for matrix synthesis. However, a combined approach using gene and cell therapy in an atelocollagen scaffold has not yet been attempted. MATERIALS AND METHODS: Rabbit IVD cells were transduced with Ad/TGF-beta1 and Ad/BMP-2. The cells were then implanted to the atelocollagen scaffold. The [methyl-3H]thymidine incorporation for DNA synthesis and the [35S]sulfur incorporation for proteoglycan synthesis were measured. RT-PCR was performed for assessing the aggrecan, collagen type I, collagen type II and osteocalcin mRNA expressions. RESULTS: The rabbit IVD cells with Ad/TGF-beta1 and that were cultured in type I atelocollagen showed a 130% increase in new proteoglycan synthesis, while the rabbit IVD cells with Ad/TGF-beta1 and that were cultured in type II atelocollagen showed a 180% increase in new proteoglycan synthesis (p<0.05). The rabbit IVD cells with Ad/BMP-2 and that were cultured in type I atelocollagen showed a 70% increase in new proteoglycan synthesis, while the rabbit IVD cells with Ad/BMP-2 and that were cultured in type II atelocollagen showed a 95% increase (p<0.05). Rabbit IVD cells with Ad/TGF-beta1 and Ad/BMP-2 and that were cultured in type I and II atelocollagen demonstrated increased collagen type I and II mRNA expressions without an osteocalcin mRNA expression (p<0.05). CONCLUSION: Cell and gene therapy in an atelocollagen scaffold provided a efficient mechanism for chondrogenic matrix regeneration of rabbit IVD cells.
Aggrecans ; Collagen ; Collagen Type I ; Collagen Type II ; DNA ; Genetic Therapy ; Intercellular Signaling Peptides and Proteins ; Intervertebral Disc ; Osteocalcin ; Proteoglycans ; Regeneration ; RNA, Messenger ; Tissue Engineering ; Tissue Therapy ; Transforming Growth Factor beta1

A 55-year-old man with massive pulmonary thromboembolism underwent thrombolysis, pulmonary artery embolectomy and tricuspid annuloplasty. Nine months later, a mobile echogenic intra-cardiac mass was found in the tricuspid valve. Because the patient had undergone annuloplasty, thrombosis was suspected as the most likely diagnosis and thrombolytic therapy was instituted. However, the size of the cardiac mass did not change and after surgical excision the mass was found to be a myxoma. Cardiac valvular tumors are uncommon and when they occur they are usually slow growing fibroelastomas. In this case, the rapid growing cardiac myxoma on the tricuspid valve was found after the occurrence of pulmonary thromboembolism. To our knowledge, this is first reported case of tricuspid valve myxoma in Korea.
Embolectomy ; Humans ; Korea ; Middle Aged ; Myxoma ; Pulmonary Artery ; Pulmonary Embolism ; Thrombolytic Therapy ; Thrombosis ; Tricuspid Valve

BACKGROUND: This study evaluates the bacterial pathogens of Ventilator-associated pneumonia (VAP) in a tertiary referral hospital. METHODS: A total of 109 bacterial pathogens from 91 adult patients with VAP, who were admitted to the medical intensive care unit from January 2008 to December 2009, were examined. Clinical characteristics, bacterial pathogens, and resistance profiles were analyzed. RESULTS: Staphylococcus aureus (44%) was the most frequently isolated. Acinetobacter baumanii (30%), Pseudomonas aeruginosa (12%), Stenotrophomonas maltophilia (7%), Klebsiella pneumoniae (6%), and Serratia marcescens (2%) were isolated from the transtracheal aspirates or bronchoalveolar lavage in patients with VAP. There was no significant difference of bacterial pathogens between early and late onset VAP. All isolated S. aureus were methicillin resistant S. aureus; the imipenem resistance rate of A. baumanii was 69%. CONCLUSION: The two most frequent pathogens of VAP were S. aureus and A. baumanii. There were no pathogenic differences between early and late onset VAP.
Acinetobacter ; Adult ; Bronchoalveolar Lavage ; Humans ; Imipenem ; Intensive Care Units ; Klebsiella pneumoniae ; Methicillin Resistance ; Pneumonia, Ventilator-Associated ; Pseudomonas aeruginosa ; Referral and Consultation ; Serratia marcescens ; Staphylococcus aureus ; Stenotrophomonas maltophilia ; Tertiary Care Centers ; Ventilators, Mechanical

BACKGROUND: This study evaluates the bacterial pathogens of Ventilator-associated pneumonia (VAP) in a tertiary referral hospital. METHODS: A total of 109 bacterial pathogens from 91 adult patients with VAP, who were admitted to the medical intensive care unit from January 2008 to December 2009, were examined. Clinical characteristics, bacterial pathogens, and resistance profiles were analyzed. RESULTS: Staphylococcus aureus (44%) was the most frequently isolated. Acinetobacter baumanii (30%), Pseudomonas aeruginosa (12%), Stenotrophomonas maltophilia (7%), Klebsiella pneumoniae (6%), and Serratia marcescens (2%) were isolated from the transtracheal aspirates or bronchoalveolar lavage in patients with VAP. There was no significant difference of bacterial pathogens between early and late onset VAP. All isolated S. aureus were methicillin resistant S. aureus; the imipenem resistance rate of A. baumanii was 69%. CONCLUSION: The two most frequent pathogens of VAP were S. aureus and A. baumanii. There were no pathogenic differences between early and late onset VAP.
Acinetobacter ; Adult ; Bronchoalveolar Lavage ; Humans ; Imipenem ; Intensive Care Units ; Klebsiella pneumoniae ; Methicillin Resistance ; Pneumonia, Ventilator-Associated ; Pseudomonas aeruginosa ; Referral and Consultation ; Serratia marcescens ; Staphylococcus aureus ; Stenotrophomonas maltophilia ; Tertiary Care Centers ; Ventilators, Mechanical

PURPOSE: The purpose of this study is to investigate the mechanism of cellular proliferation of electromagnetic field (EMF) on human intervertebral disc (IVD) cells. MATERIALS AND METHODS: Human IVD cells were cultured three-dimensionally in alginate beads. EMF was exposed to IVD cells with 650Omega, 1.8 millitesla magnetic flux density, 60 Hz sinusoidal wave. Cultures were divided into a control and EMF group. Cytotoxicity, DNA synthesis and proteoglycan synthesis were measured by MTT assay, [3H]-thymidine, and [35S]-sulfate incorporation. To detect phenotypical expression, reverse transcription-polymerase chain reactions (RT-PCR) were performed for aggrecan, collagen type I, and type II mRNA expression. To assess action mechanism of EMF, IVD cells were exposed to EMF with NG-Monomethyl-L-arginine (NMMA) and acetylsalicylic acid (ASA). RESULTS: There was no cytotoxicity in IVD cells with the EMF group in MTT assay. Cellular proliferation was observed in the EMF group (p < 0.05). There was no difference in newly synthesized proteoglycan normalized by DNA synthesis between the EMF group and the control. Cultures with EMF showed no significant change in the expression of aggrecan, type I, and type II collagen mRNA compared to the control group. Cultures with NMMA (blocker of nitric oxide) or ASA (blocker of prostaglandin E2) exposed to EMF demonstrated decreased DNA synthesis compared to control cultures without NMMA or ASA (p < 0.05). CONCLUSION: EMF stimulated DNA synthesis in human IVD cells while no significant effect on proteoglycan synthesis and chondrogenic phenotype expressions. DNA synthesis was partially mediated by nitric oxide and prostaglandin E2. EMF can be utilized to stimulate proliferation of IVD cells, which may provide efficient cell amplification in cell therapy to degenerative disc disease.
Adult ; Aspirin/pharmacology ; Cell Proliferation/*radiation effects ; Collagen/metabolism ; Dinoprostone/metabolism ; *Electromagnetic Fields ; Enzyme Inhibitors/pharmacology ; Female ; Humans ; Intervertebral Disk/*pathology/radiation effects ; Male ; Middle Aged ; Nitric Oxide/metabolism ; Tetrazolium Salts/pharmacology ; Thiazoles/pharmacology ; omega-N-Methylarginine/pharmacology

Objective: This study examined the difference in procalcitonin between sepsis and septic shock. Methods: The single-center retrospective cohort study was conducted from July 2017 to June 2018 at an emergency department (ED) of a university hospital. The inclusion criteria were patients over 18 years old who visited the ED with an infection. The exclusion criteria were the patients without organ failure by sepsis-3 definition, those with missing serum lactate data, and those discharged without workup. The sepsis patients were divided into those with and without septic shock, and the two groups were compared with biomarkers, including procalcitonin. Results: Of the 406 patients who visited the ED with an infection, 36 were excluded because they did not have sepsis or an unknown infection. Finally, 369 patients were enrolled, and 61.5% fitted the septic shock definition. A comparison of the septic shock and non-shock sepsis groups showed that a history of chronic liver disease, malignancy, pulse rate, prothrombin time, blood urea nitrogen, aspartate and alanine transaminase, troponin-I, Sequential Organ Failure Assessment score and procalcitonin levels were significantly higher in the septic shock group. In multivariate analysis, however, procalcitonin was an independent predictor for septic shock (adjusted odd ratio, 1.05; 95% confidential interval, 1.01-1.09). The area under the receiver operating characteristic curve was 0.729, and the cutoff value was 4.0 ng/mL. Conclusion The procalcitonin levels were higher in the septic shock group than in the non-shock sepsis group. This could help predict septic shock independently. Further prospective multicenter research is needed to determine if procalcitonin can predict the severity of sepsis.