The pneumonia severity index (PSI) and CURB-65 are widely used tools for the prediction of community-acquired pneumonia (CAP). This study was conducted to evaluate validation of severity scoring system including the PSI and CURB-65 scores of Korean CAP patients. In the prospective CAP cohort (participated in by 14 hospitals in Korea from January 2009 to September 2011), 883 patients aged over 18 yr were studied. The 30-day mortalities of all patients were calculated with their PSI index classes and CURB scores. The overall mortality rate was 4.5% (40/883). The mortality rates per CURB-65 score were as follows: score 0, 2.3% (6/260); score 1, 4.0% (12/300); score 2, 6.0% (13/216); score 3, 5.7% (5/88); score 4, 23.5% (4/17); and score 5, 0% (0/2). Mortality rate with PSI risk class were as follows: I, 2.3% (4/174); II, 2.7% (5/182); III, 2.3% (5/213); IV, 4.5% (11/245); and V, 21.7% (15/69). The subgroup mortality rate of Korean CAP patients varies based on the severity scores and CURB-65 is more valid for the lower scores, and PSI, for the higher scores. Thus, these variations must be considered when using PSI and CURB-65 for CAP in Korean patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Cohort Studies ; Community-Acquired Infections/*mortality ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pneumonia/*mortality ; Prospective Studies ; Republic of Korea ; *Severity of Illness Index ; Young Adult

Spontaneous hemothorax vary in cause and are rare for hemothorax induced osteochondroma. Sometimes hemothroax is reported due to osteochondroma induced injury of diaphragm, lung, pericardium, heart, or pleura. We report a patient with diaphragm laceration due to osteochondroma.
Diaphragm* ; Heart ; Hemothorax* ; Humans ; Lacerations* ; Lung ; Osteochondroma* ; Pericardium ; Pleura ; Ribs*

BACKGROUND: We investigated the effect of donor marrow T cell depletion, administration of FK506, cyclosporin A (CSA), and 3-deazaadenosine (DZA) on graft versus host disease (GVHD) after allogeneic murine hematopoietic stem cell transplantation (HSCT). METHODS: We used 4 to 6 week old Balb/c (H-2(d), recipient), and C3H/He (H-2(k), donor) mice. Total body irradiated recipients received 1x10(7) bone marrow cells (BM) and 0.5x10(7) splenocytes of donor under FK506 (36 mg/kg/day), CSA (5 mg/kg/day, 20 mg/kg/day), and DZA (45 mg/kg/day), which were injected intraperitoneally from day 1 to day 14 daily and then three times a week for another 2 weeks. To prevent the GVHD, irradiated Balb/c mice were transplanted with 1x10(7) rotor-off (R/O) cells of donor BM. The severity of GVHD was assessed daily by clinical scoring method. RESULTS: All experimental groups were well grafted after HSCT. Mice in experimental group showed higher GVHD score and more rapid progression of GVHD than the mice with R/O cells (R/O group) (p<0.01). There were relatively low GVHD scores and slow progressions in FK506 and low dose CSAgroups than high dose CSA group (p<0.01). The survival was better in FK506 group than low dose CSA group. All mice treated with CSA died within 12 days after HSCT. The GVHD score in DZA group was low and slow in comparison with control group (p<0.05), but severity and progression were similar with low dose CSA group (p=0.11). All mice without immunosuppressive treatment died within 8 days, but all survived in R/O group (p<0.01). Survival in low dose CSA group was longer than in control group (p<0.05), but in high dose CSA group, survival was similar to control group. The survival benefit in DZA group was similar with low dose CSA group. FK506 group has the best survival benefit than other groups (p<0.01), comparable with R/O group (p=0.18), although probability of survival was 60%. CONCLUSION: We developed lethal GVHD model after allogeneic murine HSCT. In this model, immunosuppressive agents showed survival benefits in prevention of GVHD. DZA showed similar survival benefits to low dose CSA. We propose that DZA can be used as a new immunosuppressive agent to prevent GVHD after allogeneic HSCT.
Animals ; Bone Marrow ; Bone Marrow Cells ; Cyclosporine* ; Graft vs Host Disease* ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Immunosuppressive Agents ; Mice ; Research Design ; Tacrolimus* ; Tissue Donors ; Transplants

BACKGROUND: Clinical and biologic characteristics of elderly patients with acute myeloid leukemia (AML) have not been well defined yet and there is no consensus on the appropriate treatment approach. We analyzed the outcome of these patients in terms of complete remission (CR) and the long-term life expectancy. METHODS: Twenty patients received mitoxantrone at the dose range of 4~8 mg/m2/ day for 3 days according to the patients' condition based on age and performance status, low-dose cytosine arabinoside 10mg/m2 subcutaneously at every 12 hours for 10~14 days, and etoposide 100mg/day per os for 10~14 days. Most of patients achieving CR received at least 1~3 more courses of post-remission therapy with same initial regimen. Nine out of 17 patients receiving more than two courses of post-remission chemotherapy received their cryopreserved peripheral bloods stem cells after the second or third consolidation chemotherapy. RESULTS: Overall, CR was achieved in 16 (80%) out of 20 patients and the median CR duration was 6 months (range 2~17 months). The most frequent complication during the induction chemotherapy was pneumonia (55%). CONCLUSION: The induction chemotherapy regimen including mitoxantrone, cytosine arabinoside, and etoposide seems to be promising in elderly AML patients in terms of CR rate, while its duration was short. Hopefully, it is necessary to develop a new post-remission therapy to maintain long-term disease-free survival in elderly AML patients.
Aged ; Consensus ; Consolidation Chemotherapy ; Cytarabine ; Disease-Free Survival ; Drug Therapy ; Etoposide ; Humans ; Induction Chemotherapy* ; Leukemia, Myeloid, Acute* ; Life Expectancy ; Mitoxantrone ; Pneumonia ; Population Characteristics ; Stem Cells

The distribution of the nerve growth factor (NGF), the glial fibrillary acidic protein (GFAP) and the ciliary neurotrohic factor (CNTF) was performed in coronal sections of the mesencephalon, rhombencephalon and spinal cord in the developing Mongolian gerbils. Generally, NGF specifically recognizes neurons with the NGF receptor, whereas GFAP does the glia, and CNTF does the motor neurons. The receptor expression was examined separately in gerbils between embryonic days 15 (E15) and postnatal weeks 3 (PNW 3). The NGF-IR was first observed in the spinal cord at E21, which might be related to the maturation. The GFAP reactivity was peaked at the postnatal days 2 (PND2), while the highest CNTF-reaction was expressed at PNW 2. The GFAP stains were observed in the aqueduct and the spinal cord, which appeared to project laterally at E19. The CNTF was observed only after the birth and found in both the neurons and neuroglia of the substantia nigra, mesencephalon, cerebellum and the spinal cord from PND1 to PNW3. These results suggest that NGF, GFAP and CNTF are important for the development of the neurons and the neuroglia in the central nervous system at the late prenatal and postnatal stages.
Animals ; Brain Stem/enzymology/*metabolism ; Ciliary Neurotrophic Factor/*metabolism ; Embryonic and Fetal Development/physiology ; Female ; Gerbillinae/*embryology ; Glial Fibrillary Acidic Protein/*metabolism ; Immunohistochemistry/veterinary ; Mesencephalon/embryology/metabolism ; Nerve Growth Factor/*metabolism ; Pregnancy ; Rhombencephalon/embryology/metabolism ; Spinal Cord/embryology/*metabolism

Reported cases of gastrosplenic fistulas are extremely rare in the literature. Malignancy is the primary cause in 50% of patients, followed by perforated peptic ulcer (40%). Fistulas can cause spleen rupture and potential bleeding that threaten the life of the patient. Lymphoma is the most common cause of malignancy complicated with gastrosplenic fistula. Most gastrosplenic fistulae caused by lymphoma eventually close following chemotherapy, although splenectomy should be performed to avoid further complications. We experienced a case of non-Hodgkin's lymphoma complicated with gastrosplenic fistula in a 21 year-old man. He was admitted to our hospital because of LUQ mass. On the abdominal CT, a splenic mass with central necrosis and gas was discovered. The biopsy specimen of the stomach and spleen displayed diffuse, large B cell type non-Hodgkin's lymphoma. After one cycle of CHOP chemotherapy, the LUQ mass was markedly regressed although the gastrosplenic fistula was still present on the follow-up CT. The fistula was treated by splenectomy and a partial resection of gastric fundus. Follow-up chemotherapy was continued after surgery.
Biopsy ; Drug Therapy ; Fistula* ; Follow-Up Studies ; Gastric Fundus ; Hemorrhage ; Hodgkin Disease* ; Humans ; Lymphoma ; Lymphoma, Non-Hodgkin ; Necrosis ; Peptic Ulcer ; Rupture ; Spleen ; Splenectomy ; Stomach ; Tomography, X-Ray Computed ; Young Adult

BACKGROUND: The green fluorescent protein (GFP) from jelly fish, Aequorea victoria, has become a versatile reporter for monitoring gene expression in a variety of cells and organisms. Using GFP as a marker protein we studied whether there are any differencies in the expression patterns among organs in mouse after intravenous injection of adenovirus vectors with GFP gene. METHODS: Recombinant E1, E3-defective type 5 adenovirus vectors (2x10(8)/mouse) with CMV promoter and GFP gene were injected into mice via tail vein. On 3, 6, 9, 14, 21, 28 days after gene transfer, 5 mice per experiments were sacrificed by cervical dislocation and obtained liver, lung, heart, kidney, spleen, small intestine and bone. Half of them were examined by optical microscope after H-E stain. Another half were examined by fluorescent microscope after frozen section. Western blottings were done for each samples with anti-GFP monoclonal antibody and obtained GFP bands were quantitatively compared using Gel-Doc (Bio-Rad, USA) image analyzer. RESULTS: In all organs that we obtained, expression of GFPs are noticed 3 days after gene transfer and reached a maximum around 9th to 14th days, after then the intensities are slightly decreased but maintained until 28th days as determined by Western blotting. On fluorescent microscopic examination, GFPs are well and most frequently expressed on lung among all the examined organs. There are little expression of GFPs on liver parenchymal area around the sinusoids and central veins, although patchy expression of GFPs are observed along the liver capsules. GFPs are highly expressed around the splenic trabecula area but splenic pulp area, it is very sparsely expressed. GFPs are more frequently and highly expressed around the renal tubular area than gromerular area in kidneys. In small intestine, GFPs are expressed on mid portion of microvilli. GFPs are not expressed on myocardium except scanty expression on endocardium. Bone marrow showed GFPs but precise localization is difficult because bony spicules mashed bone marrow during the preparation of frozen section. No specific pathologic lesions possibly related with adenovirus administration are observed on microscopic examination of H-E stained specimens. CONCLUSIONS: GFPs can be detected in cells without the fixing and staining and a good marker to studying the kinetics and persistence of adenovirus mediated gene therapy. And there are different GFP expression patterns according to the organs after intravenous injection of adenovirus vectors with GFP gene in mouse.
Adenoviridae* ; Animals ; Blotting, Western ; Bone Marrow ; Capsules ; Dislocations ; Endocardium ; Fluorescence ; Frozen Sections ; Gene Expression ; Genetic Markers ; Genetic Therapy ; Heart ; Injections, Intravenous* ; Intestine, Small ; Kidney ; Kinetics ; Liver ; Lung ; Mice* ; Microvilli ; Myocardium ; Spleen ; Veins ; Victoria

BACKGROUND: The development of metastasis in cancer is one of the main problems after primary tumor resection. The identification of metastases is only possible in the follow-up investigation when there is already a solid tumor mass. Subclinical tumor cell dissemination can be detected by immunocytological staining of cells or by other molecular biological methods, like PCR. We investigated 22 peripheral blood isolates from gastric cancer patients with a cytokeratin (CK) 20 specific nested reverse transcriptase PCR (RT-PCR) for the detection of disseminated tumor cells at the time of diagnosis. METHODS: Fresh heparinized peripheral bloods (about 10 mL) were obtained from 22 gastric cancer patients and 10 healthy doctors as controls. Nucleated cells were isolated by a density gradient method. RNA was isolated and then subjected to RT-PCR with CK 20 specific primers. RESULTS: In gastric cancer, 3 of 22 (13.6%) peripheral blood isolates yielded a CK 20 mRNA positive result in a stage undependent manner. CONCLUSION: We detected disseminated tumor cells in the peripheral blood isolated using CK 20 specific nested RT-PCR method. Studies on a larger scale are needed for further investigation on the relationship between positive rates of CK 20 mRNA and survival rates of stomach cancer, according to cancer stages.
Diagnosis ; Follow-Up Studies ; Heparin ; Humans ; Keratin-20* ; Keratins* ; Neoplasm Metastasis ; Polymerase Chain Reaction ; Reverse Transcriptase Polymerase Chain Reaction* ; RNA ; RNA, Messenger ; RNA-Directed DNA Polymerase* ; Stomach Neoplasms* ; Survival Rate

GFAP (Glial Fibrillary Acidic Protein) was one of the intermediate filament group and used as an astrocyte marker. The numerous studies about GFAP immunoreactive cell's distribution were investigated for fetus, neonate and aged brains. There are several reports about that GFAP immunoreactive cells were appeared at early fetus or after birth. In cases of mammalian fetus radial glia cells migrated toward pial surface at early stage and revealed GFAP immunoreactivity by the immunostain. But in cases of rodents, they migrated last gestation or after birth. This study, the GFAP immunoreactive cells' localizations and distribution in the fetuses (the 30th, 45th, 60th, 90th, 95th, 105th 120th of gestation) and neonate telencephalon of Korean native goat were investigated by immunohisto-chemistry (ABC method). The results obtained in this study were summarized as followings; 1. Multipolar astrocytes of 60 days of gestation were found cerebral cortex, in 95 days of gestation were found cerebral medulla, in 105 days of gestation were found lateral ventricle. 2. Radial glial cell presented 45 days of gestation and process of GFAP immunoreactive was to stretch out from ventricular to pia mater. And the nonpolar immunoreactive cells were transformed bipolar immunoreactive cells and they were transformed to monopolar and multipolar immunoreactive cell. 3. The number of GFAP immunoreactive cells of a field were gradually increased from 45 days of gestation till 90 days of gestation and decreased from 90 days of gestation till 105 days of gestation. But in 120 days of gestation and newborn were slightly increased. 4. Immunoreactivity of GFAP immunoreactive cells were gradually decreased from 95 days of gestation till 120 days of gestatioin. However, most pia mater areas and ventricles had high immunoreactivity and medulla part had low immunoreactivity. These results were suggested that radial glial cell of cerebral cortex and cerebral medulla were developed faster than lateral ventricle.
Astrocytes ; Brain ; Cerebral Cortex ; Ependymoglial Cells ; Fetus* ; Goats* ; Humans ; Immunohistochemistry ; Infant, Newborn* ; Intermediate Filaments ; Lateral Ventricles ; Neuroglia ; Parturition ; Pia Mater ; Pregnancy ; Rodentia ; Telencephalon*

GFAP (Glial Fibrillary Acidic Protein) was one of the intermediate filament group and used as an astrocyte marker. The numerous studies about GFAP immunoreactive cell's distribution were investigated for fetus, neonate and aged brains. There are several reports about that GFAP immunoreactive cells were appeared at early fetus and after birth. In cases of mammalian fetus radial glia cells migrated toward pial surface at early stage and revealed GFAP immunoreactivity by the immunostain. But in cases of rodents, they migrated at late gestation or after birth. This study, the GFAP immunoreactive cells' localizations and distribution in the fetuses (the 30 th, 45 th, 60 th, 90 th, 105 th, 120 th of gestation) and neonate mesencephalon of korean native goat were investigated by immunohistoche-mistry (ABC method). The results obtained in this study were summarized as followings; 1. Multipolar astrocytes at 60 days of gestation were found in midbrain, in 90 days of gestation were found in cerebral aqueduct. 2. Radial glial cell presented 60 days of gestation and process of GFAP immunoreaction was to stretch out from ventricular to pia mater and nonpolar immunoreactive cell was transformed to bipolar, monopolar and multipolar immunoreactive cell. 3. The number of GFAP immunoreactive cells of field were gradually decreased from 90 days of gestation till 105 days of gestation. But in 120 days of gestation and newborn were slightly increased. 4. Immunoreactivity of GFAP immunoreactive cells were gradually decreased from 95 days of gestation till 120 days of gestatioin. These results were suggested that radial glial cell of midbrain developed very earlier than that of cerebral aqueduct. However, cerebral aqueduct developed lately than that of midbrain, but faster developing than other.
Astrocytes ; Brain ; Cerebral Aqueduct ; Ependymoglial Cells ; Fetus* ; Goats* ; Humans ; Infant, Newborn* ; Intermediate Filaments ; Mesencephalon* ; Neuroglia ; Parturition ; Pia Mater ; Pregnancy ; Rodentia