STUDY DESIGN: A noninterventional, multicenter, cross-sectional study. PURPOSE: We investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: Among patients with CLBP, 20%–55% had NP. METHODS: Patients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4 < 4) groups. RESULTS: A total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%–43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; p < 0.01), in patients who had pain based on radiological and neurological findings (59.0%; p < 0.01), and in patients who had severe pain (49.0%; p < 0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; p < 0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; p < 0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (β=−0.1; p < 0.01) and higher QBPDS (β=7.0; p < 0.01) scores than those without NP. CONCLUSIONS: NP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.
Adult* ; Back Pain ; Cross-Sectional Studies ; Diagnosis ; Hospitals, General ; Humans ; Linear Models ; Low Back Pain* ; Male ; Neuralgia* ; Prevalence* ; Quality of Life ; Visual Analog Scale

BACKGROUND: Inter-observer and intra-observer variation in histologic tumor grading are well documented. To determine whether histologic disorderliness in the arrangement of tumor cells may serve as an objective criterion for grading, we tested the hypothesis the degree of disorderliness is related to the degree of tumor differentiation on which tumor grading is primarily based. METHODS: Borrowing from the statistical thermodynamic definition of entropy, we defined a novel mathematical formula to compute the relative degree of histologic disorderliness of tumor cells. We then analyzed a total of 51 photomicrographs of normal colorectal mucosa and colorectal adenocarcinoma with varying degrees of differentiation using our formula. RESULTS: A one-way analysis of variance followed by post hoc pairwise comparisons using Bonferroni correction indicated that the mean disorderliness score was the lowest for the normal colorectal mucosa and increased with decreasing tumor differentiation. CONCLUSIONS: Disorderliness, a pathologic feature of malignant tumors that originate from highly organized structures is useful as an objective tumor grading proxy in the field of digital pathology.
Adenocarcinoma ; Colonic Neoplasms ; Entropy ; Humans ; Mucous Membrane ; Neoplasm Grading ; Observer Variation ; Pathology ; Proxy ; Thermodynamics

Ischemic steal syndrome (ISS) is one of the serious complications that can occur after construction of an arteriovenous fistula (AVF) for hemodialysis (HD). Because AVF-related ISS symptoms are usually aggravated during HD sessions, a few cases of ISS in kidney transplantation (KT) recipients have been reported in the literature. We describe a 63-year-old male with diabetic nephropathy who created AVF for maintenance HD and presented with pain at rest and tissue necrosis of the left distal fingers at 10 years post-KT. Brachial angiography revealed the presence of attenuated blood flow through the distal ulnar artery. He underwent finger amputation and AVF ligation, leading to complete relief of ischemic symptoms. The aim of this case report is to help clinicians to diagnosis a steal syndrome in kidney transplantation with a careless AVF for a long period of time.
Amputation ; Angiography ; Arteriovenous Fistula ; Diabetic Nephropathies ; Diagnosis ; Fingers ; Humans ; Kidney Transplantation* ; Ligation ; Male ; Middle Aged ; Necrosis ; Renal Dialysis ; Ulnar Artery

PURPOSE: Long-term exposure to extremely low-frequency (60 Hz) electromagnetic fields (ELF-EMF) raises the questions of the induction of biological effects including tumorigenesis. One mechanism through which ELF-MFS could influence neoplastic development is the imbalance of cellular proliferation and cell apoptosis. The present study investigated the effect of ELF-EMF on chemically-induced thyroid carcinogenesis in a rat. METHODS: We examined cellular proliferation index measured by anti-Ki-67 antigen, apoptosis, apoptosis related proteins such as caspase 3 and p53, and cell cycle-related proteins (cyclin D1 and p21(WAF1/Cip1)). Forty Male F344 rats received a subcutaneous N-bis(2-hydroxypropyl)nitrosamine (DHPN, 2,800 mg/kg) injection, and 1 week later were allowed free access to drinking water containing sulfadimethoxine (0.1%) for 12 weeks. Twenty rats were exposed by ELF-EMF. During the carcinogenesis, sequential histological changes from hyperplasia, adenoma, and ultimately to overt carcinomas were noted. RESULTS: The exposure group of ELF-EMF, significantly increases the number size of carcinomas. Also, the proliferative and apoptotic indices were significantly increased in the ELF-EMF exposure group than in the control group. The caspase 3 protein expression did not show any significant changes between ELF-EMF group and control group. The p53 protein was not detected in both ELF-EMF exposure and control group. Among the cell cycle related proteins, cyclin D1, not p21(WAF1/Cip1), was significantly increased in adenomas and carcinomas in ELF-EMF exposure group compared with the control group. CONCLUSION: Exposure of ELF-EMF effects on chemically-induced rat thyroid carcinogenesis as results of altered increase of cellular proliferation, apoptosis, and cyclin D1 expression.
Adenoma ; Animals ; Apoptosis ; Caspase 3 ; Cell Cycle ; Cell Proliferation ; Cell Transformation, Neoplastic ; Cyclin D1 ; Drinking Water ; Electromagnetic Fields ; Humans ; Hyperplasia ; Male ; Nitrosamines ; Proteins ; Rats ; Rats, Inbred F344 ; Sulfadimethoxine ; Thyroid Gland

PURPOSE: Oxalobacter formigenes (O. formigenes) is an obligate anaerobe, which may be important in the prevention of stone formation. O. formigenes degrades oxalates using oxalyl-CoA decarboxylase and formyl- CoA transferase encoded by the oxc and frc genes, respectively. Attempts were made to develop recombinant Escherichia coli (E. coli) expressing both the oxc and frc genes of O. formigenenes. MATERIALS AND METHODS: After the extraction of total RNA from O. formigenes, a reverse transcriptase-polymerase chain reaction (RT-PCR) was carried out using primers synthesized according to the oxc and frc genes reported in GenBank. The cloned cDNA encoding oxalyl-CoA decarboxylase and formyl-CoA transferase was introduced into the pET-22b (+) plasmid vector. The constructs were verified by restriction analysis and DNA sequencing. The plasmid vector containing the cDNA fragment was transformed into competent E. coli BL21 (DE3). The recombinant E. coli was then analyzed using SD-SPAGE for the protein expressions of oxc and frc gene products, and visualized by staining with Coomassie Blue. RESULTS: Restriction enzyme and sequence analyses showed the gene cloned into the pET-22b (+) plasmid vector was identical to the reported oxc and frc genes. After the transformation into the competent E. coli, the SDS-PAGE analysis showed the recombinant E. coli expressed the proteins migrating at 66 and 50KD, which was identical to the reported weight of oxalyl-CoA decarboxylase and formyl-CoA transferase. CONCLISIONS: A recombinant E. coli, expressing oxc and frc genes, was successfully produced. Further studies may be necessary to investigate their enzymatic activities on the degradation of oxalate in the development of a new therapeutic strategy for the prevention of stone formation.
Clone Cells ; Databases, Nucleic Acid ; DNA, Complementary ; Electrophoresis, Polyacrylamide Gel ; Escherichia coli* ; Escherichia* ; Oxalates ; Oxalobacter formigenes* ; Plasmids ; RNA ; Sequence Analysis ; Sequence Analysis, DNA ; Transferases

Monitoring temporal trends of antimicrobial resistance can provide useful information for the empirical selection of antimicrobial agents to treat infected patients and for the control of nosocomial infections. In this study, we analyzed antimicrobial resistance of clinically relevant bacteria in 2003 at Korean hospitals and at a commercial laboratory. The following organism-antimicrobial agent resistance combinations were very prevalent: oxacillin-resistant Staphylococcus aureus (68%), expanded-spectrum cephalosporin-resistant Klebsiella pneumoniae (25%), and fluoroquinolone-resistant Escherichia coli (33%), Acinetobacter spp. (58%), and Pseudomonas aeruginosa (40%). Moreover, gradual increases in vancomycin-resistant Enterococcus faecium (20%), cefoxitin-resistant E. coli (10%) and K. pneumoniae (23%), and imipenem-resistant P. aeruginosa (20%) and Acinetobacter spp. (13%) were also observed. The resistance rates of Acinetobacter spp. to most antimicrobial agents at hospitals and at the commercial laboratory were similar. Among the Acinetobacter spp. isolated at a tertiary-care hospital, 46.2% were multidrug-resistant to 9-12 of 13 antimicrobial agents, and 18.3% were panresistant. The exclusion of duplicate isolates at a tertiary-care hospital significantly lowered the proportion of oxacillin-resistant S. aureus, vancomycin-resistant E. faecium, and fluoroquinolone-resistant E. coli.
Vancomycin Resistance ; Vancomycin/pharmacology ; Population Surveillance ; Microbial Sensitivity Tests ; Korea/epidemiology ; Klebsiella pneumoniae/drug effects/isolation & purification ; Klebsiella Infections/drug therapy/epidemiology/microbiology ; Imipenem/pharmacology ; Humans ; Gram-Positive Bacterial Infections/drug therapy/epidemiology/*microbiology ; Gram-Negative Bacterial Infections/drug therapy/epidemiology/*microbiology ; Gammaproteobacteria/*drug effects/isolation & purification ; Fluoroquinolones/pharmacology ; Enterococcus faecium/*drug effects/isolation & purification ; *Drug Resistance, Bacterial ; Anti-Bacterial Agents/*pharmacology ; Amikacin/pharmacology ; Acinetobacter Infections/drug therapy/epidemiology/microbiology ; Acinetobacter/drug effects/isolation & purification

Multiple primary malignant neoplasm means that more than 2 cancers are independently developed in one individual. In general, the neoplasms are diagnosed simultaneously or within 6 month interval. Simultaneous presentation of carcinomas involving ovary and uterus is not a common event and presents a diagnostic dilemma when they are of the same histology. We experienced a rare case of multiple primary malignant neoplasm involving the uterine endometrium and the ovary synchronously. Thus we report this case with a review of literatures.
Endometrium* ; Female ; Ovary* ; Uterus

Grapefruit seed extract has been reported to have antimicrobial effect. The purpose of this study was to evaluate the antimicrobial and anti-gingivitis effect of chewing gum containing grapefruit seed extract and xylitol. 40 healthy subjects with gingivitis or early periodontitis were divided into two groups. Subjects in the experimental group chewed gum containing grapefruit seed extract and xylitol while subjects in the control group chewed gum containing only xylitol. All subjects received scaling and tooth brushing instruction. 1 week after scaling was set as baseline. Gingival index and plaque index were scored at baseline, 1 week, 2 week, 3 week and 4 week. Bleeding index, probing pocket depth and clinical attachment level were scored at baseline, 2 week and 4 week. The number of total bacteria and Streptococcus mutans in unstimulated saliva of experimental group were counted at 1 week, 2 week, 3 week and 4 week. Gingival indices of experimental group and control group at baseline, 1 week, 2 week, 3 week and 4 week were 0.850+/-0.298, 0.575+/-0.345, 0.533+/-0.332, 0.459+/-0.311, 0.408+/-0.224 and 0.758+/-0.379, 0.592+/-0.296, 0.563+/-0.281, 0.454+/-0.194, 0.413+/-0.199 (mean+/-SD), respectively. Plaque indices of experimental group and control group at baseline, 1 week, 2 week, 3 week and 4 week were 0.497+/-0.500, 0.375+/-0.484, 0.332+/-0.471, 0.286+/-0.452, 0.210+/-0.407 and 0.411+/-0.492, 0.375+/-0.484, 0.354+/-0.479, 0.313+/-0.463, 0.193+/-0.395, respectively. Bleeding indices of experimental group and control group at baseline, 2 week and 4 week were 0.377+/-0.177, 0.298+/-0.152, 0.192+/-0.108 and 0.383+/-0.124, 0.318+/-0.153, 0.225+/-0.126, respectively. Probing pocket depth of experimental group and control group at baseline, 2 week and 4 week were 2.56+/-1.00, 2.40+/-0.65, 2.23+/-0.64 and 2.45+/-0.68, 2.37+/-0.57, 2.19+/-0.57, respectively. Clinical attachment level of experimental group and control group at baseline, 2 week and 4 week were 2.58+/-1.01, 2.43+/-0.67, 2.26+/-0.65 and 2.49+/-0.70, 2.40+/-0.59, 2.22+/-0.62, respectively. The % of reduction of total bacteria in saliva of experimental group at 2 week, 3 week and 4 week were 46 +/- 53%, 53 +/- 5% and 69 +/- 33%. The % of reduction of Streptococcus mutans count in saliva of experimental group at 2 week, 3 week and 4 week were 52 +/- 69%, 88 +/- 30% and 89 +/- 17%. From these findings, it can be concluded that regular use of grapefruit seed extract /xylitol chewing gum may be effective to control and prevent gingivitis and may have caries-preventive effect.

BACKGROUND: Streptococcus viridans group (SVG) is the normal flora of the upper respiratory tract, skin and genitourinary tract, and is the major causative agent isolated in 30-40% of bacterial endocarditis patients. However, SVG has not been properly identified to the species level for lack of diagnostic system which enables the accurate identification of SVG. Poyart et al. have recently described the identification of SVG to the species level by DNA sequencing of superoxide dismutase gene (sodAint). Using this method, we report here the identification of SVG isolated from the patients in Seoul National University Hospital within recent 2 years. METHODS: According to the method by Poyart et al., a set of two oligonucleotides, D1 (5 '-CCI TAY ICI TAY GAY GCI YTI GAR CC-3 ') and D2 (5 '-ARR TAR TAI GCR TGY TCC CAI ACR TC-3 ') were used as PCR primers, and PCR products of 480-bp size were obtained. The PCR products purified by MicroSpin S-400 HR Column were sequenced using ABI-PRISM 3700 Sequence Analyzer. D1 and D2 were used as sequencing primers. The clinical isolates were respectively identified as the species showing the greatest sequence homology which was demonstrated by the BLAST program provided by NCBI(USA). RESULTS: Clinical strains isolated from 26 patients who had shown two or more positive blood cultures were analyzed by DNA sequencing of superoxide dismutase gene, which showed 6 strains of S. salivarius, five S. oralis, four S. sanguis, three S. pasteuri, three S. equisimilis, two S. gordonii, one S. constellatus, one S. luteciae, and one S. mitis. S. salivarius and S. sanguis were clearly discriminated, while S. equisimilis and S. pyogenes were not. Species identification results by conventional method seldom corresponded to those by DNA sequencing. Among 7 patients suspected to have bacterial endocarditis, S. sanguis were isolated in 4 patients, and S. gordonii, S. oralis, S. pasteuri in one, respectively. Among 17 patients with liver cirrhosis or cancer, S. salivarius were isolated in 6 patients, and S. oralis in four. CONCLUSIONS: In this study, we could identify the species of SVG isolated from the patients with bacteremia; S. sanguis were frequently isolated from patients with bacterial endocarditis, while S. salivarius from ones with malignancy. These results imply that a different group of underlying diseases could show correspondingly different group of SVG species which cause bacteremia, and we suggest that further pathophysiological study on the correlations between underlying disease and the species of SVG be performed.
Bacteremia ; Endocarditis, Bacterial ; Homosexuality, Male ; Humans ; Liver Cirrhosis ; Male ; Oligonucleotides ; Polymerase Chain Reaction ; Respiratory System ; Seoul ; Sequence Analysis ; Sequence Analysis, DNA ; Sequence Homology ; Skin ; Streptococcus* ; Superoxide Dismutase ; Viridans Streptococci*

Ectopic pancreas rarely produces clinical symptoms. Most commonly reported symptoms were abdominal pain, epigastric discomfort, nausea, vomiting, and bleeding. However, presentation of specific symptoms due to its size and location, including obstructive jaundice, and pyloric obstruction are possible. Ectopic pancreas is subject to various pathological changes occurring in the pancreas itself; namely, cyst, pancreatitis, hemorrhage, necrosis, and neoplastic change. We present a case of 60-year old woman with right upper quadrant pain in whom the surgical pathologic diagnosis was ectopic pancreas of the stomach complicated by pancreatitis and pseudocyst formation.
Abdominal Pain ; Diagnosis ; Female ; Hemorrhage ; Humans ; Jaundice, Obstructive ; Middle Aged ; Nausea ; Necrosis ; Pancreas* ; Pancreatitis* ; Stomach ; Vomiting