BACKGROUND: Chicken pox and herpes zoster are caused by the varicella-zoster virus(VZV). To investigate the epiderniologial relationship between clinical isolates of VZV, it is essential to distinguish different isolate. OBJECTIVE: This study was conducted to classify the VZV strains according to R5 tandem direct reiterations(TDR) copy numbers and Pst I endonuclease cleavage site mutation, and to analyze the distribution pattern of VZV strains isolated in Korea. METHODS: Strains of VZV were isolated from 61 patients with herpes zoster who had not been immunized with a live vaccine of VZV. Copy numbers of R5 TDR which was located in variable region IV were measured by PCR. The presence of a Pst I cleavage site in a middle portion of the long unique region of VZV genome was analyzed by PCR thereafter restriction enzyme digestion(PCR-RFLP). RESULTS: VZV strains isolated in Korea contained one to three copy numbers of R5 TDR. Of 61 isolates, 43(70%) comtained 2 copies of R5 TDR, while 11(18%) isolates contained only one copy and 7(12%) isolat s contained 3 copies. About 16% of the strains examined did not have a PstI cleavage site, although the majority of strains retained this site. VZV strains could be classified into 6 strains on the basis of the copy number of R5 TDR and PstI cleavage site, in which the strain with 2 copies of R5 TDR and PstI cleavage site positive was the most frequent type (36 out of 61 isolates) in Korea. Four batches of live attenuated vaccine(Biken) that is now used in Korea showed 2 copy numbers of R5 TDR and PstI site negative. CONCLUSION: The copy number of R5 TDR and the presence of PstI cleavage site seems to be a reliable marker for dicrimination of VZV strains in Korea. This discrimination can be used to study the molecular epiclemiology of VZV and as a criterion for identification of vaccine-related isolates.
Chickenpox* ; Discrimination (Psychology) ; Genome ; Herpes Zoster* ; Humans ; Korea* ; Polymerase Chain Reaction ; Repetitive Sequences, Nucleic Acid*

BACKGROUND: Unlike other diseases, the management of sepsis has not been fully integrated in our daily practice. The aim of this study was to determine whether repeated training could improve compliance with a 6-h resuscitation bundle in patients with severe sepsis and septic shock. METHODS: Repeated education regarding a sepsis bundle was provided to the intensive care unit and emergency department residents, nurses, and faculties in a single university hospital. The educational program was led by a multidisciplinary team. A total of 175 adult patients with severe sepsis or septic shock were identified (88 before and 87 after the educational program). Hemodynamic resuscitation bundle and timely antibiotics administration were measured for all cases and mortality at 28 days after sepsis diagnosis was evaluated. RESULTS: The compliance rate for the sepsis resuscitation bundle before the educational program was poor (0%), and repeated training improved it to 80% (p < 0.001). The 28-day mortality was significantly lower in the intervention group (16% vs. 32%, p = 0.040). Within the intervention group, patients for whom the resuscitation bundle was successfully completed had a significantly lower 28-day mortality than other patients (11% vs. 41%, p = 0.004). CONCLUSIONS: Repeated education led by a multidisciplinary team and interdisciplinary communication improved the compliance rate of the 6-h resuscitation bundle in severe sepsis and septic shock patients. Compliance with the sepsis resuscitation bundle was associated with improved 28-day mortality in the study population.
Adult ; Anti-Bacterial Agents ; Compliance ; Critical Pathways ; Diagnosis ; Education ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Intensive Care Units ; Interdisciplinary Communication ; Mortality ; Resuscitation* ; Sepsis* ; Shock, Septic

No abstract available.
Brain* ; Mood Disorders*

Lymphoid lesions of the orbit and conjunctiva may be divided histologically into three groups: monomorphous and cytologically atypical malignant lymphomas, benign reactive follicular hyperplasia or inflammatory pseudotumor, and borderline lymphoid lesions mainly composed of small, non-atypical lymphocytes with or without evidence of plasmacytic differentiation or germinal centers which are difficult to clarify its nature by histologic criteria alone. From 1984 to 1992 at Seoul National University Hospital, 20 cases of orbital lymphoid infiltrates were reviewed to find out histopathologic characteristics of malignant lymphomas and try to classify them properly. Also, we sought histologic findings helpful for differential diagnosis between malignant and borderline cases. Histologic examination of malignant lesions usually revealed the features of low-grade B cell lymphomas of mucosa-associated lymphoid tissue(MALT) origin, which predominantly consist of centrocyte-like(CCL) cells. Among 13 primary orbital lymphomas, six cases were classified as MALT lymphomas of Isaacson, six were more apt to be the type of immunocytoma by kiel classification, and remaining one showed mixed pattern of both types in areas. The one case of malignant lymphoma with diffuse large cell type was confirmed by secondary involvement of intestinal lymphoma. Five cases were confirmed by immunoglobulin k-light chain monoclonality on flow cytometry and immunofluorescence study. The histologic findings such as Dutcher bodies, hemosiderin, deposits and polykaryocytes tended to be more frequently encountered in malignant lymphoma rather than indeterminate lesions and were thought to be helpful ones in making differential diagnosis between malignant and benign lesions. With above findings, we assume that the principal neoplastic cells in the low grade lymphoma arising in the orbit and conjunctiva are CCL cells, which might be originated from the localized memory B cells, and also several kinds of B lymphocytes in on-going differentiation stages such as medium-sized monocytoid B cell, lymphoplasmacytoid cell, plasma cell, and mature small lymphocyte also contribute to the tumor progression.
Diagnosis, Differential

This study identified an effective control method for periodontitis by investigating the association between blood levels of vitamin D and periodontitis in Korean elderly based on raw data from the fifth Korea National Health & Nutrition Examination Survey of 2010 (KNHANES). In this study, 1,021 adults over 65 years of age were evaluated based on data from the KNHANES. Periodontal disease was assessed using community periodontal index (CPI), with CPI codes ≥3 defined as periodontitis. Blood levels of vitamin D were measured from blood samples and divided into four groups (first quartile: ≤13.23 ng/ml, second quartile: 13.24∼16.95 ng/ml, third quartile: 16.96∼21.58 ng/ml), and fourth quartile >21.59 ng/ml). Using multiple logistic regression analyses, the variables were adjusted for general characteristics, oral health-related characteristics, health-related characteristics, and bone mineral density. The statistical analysis was performed using the SAS (ver. 9.2). The results of this study are as follows: the prevalence of periodontitis was 42.6% in Korean elderly. After adjusting for general, oral health-related, and health-related, the risk of periodontitis in the first quartile group was 1.74 times (95% confidence interval [CI], 1.02∼2.98) higher than that of the fourth quartile group (p=0.041). After adjusting for general, oral health-related, and health-related characteristics as well as bone mineral density, the risk of periodontitis in the first quartile group was 1.73 times (95% CI, 1.02∼2.96) higher than that of the four quartile group (p=0.042). There was a significant relationship between blood vitamin D level and periodontitis in Korean elderly. For the prevention of periodontitis, factors related to vitamin D should be considered along with other risk factors.
Adult ; Aged* ; Bone Density ; Humans ; Korea ; Logistic Models ; Methods ; Periodontal Diseases ; Periodontal Index ; Periodontitis* ; Prevalence ; Risk Factors ; Vitamin D* ; Vitamins*

No abstract available.

No abstract available.
Basal Ganglia* ; Humans

PURPOSE: To report the usefulness of optical coherence tomography (OCT) for assessing postoperative visual acuity in macula-off retinal detachment. METHODS: This prospective study included 54 patients who were operated on for macula-off retinal detachment, and who could be followed up for at least 6 months, between September 2003 and July 2005. Patients were examined at 1 day before surgery and at 1, 3, and 6 months after surgery for best corrected visual acuity, intraocular pressure, by slit lamp examination, fundus examination, and OCT. RESULTS: Preoperative best corrected visual acuities improved at 1, 3, and 6 months after surgery (p<0.05). The average period of macular reattachment with fundus examination was found to be 24 days, but with OCT it was found to be 52 days. Improvement of best corrected visual acuity was found in 40 eyes (74.1%), and among these, reattachment of the macula on OCT was found in 36 eyes (90%). Postoperative visual acuity was better when there was better preoperative visual acuity, a shorter duration of macular detachment, and when the height of the detached macula on OCT was shorter. CONCLUSIONS: Macular reattachment as determined by OCT was related to the improvement of visual acuity after surgery. We suggest that OCT is useful in patients whose macular reattachment was seen on fundus examination but whose postoperative visual acuity had not improved.
Humans ; Intraocular Pressure ; Prospective Studies ; Retinal Detachment* ; Retinaldehyde* ; Tomography, Optical Coherence* ; Visual Acuity

OBJECTIVES: The present study was performed to evaluate the change in releasing action of hypothalamus-pituitary-adrenal axis after alcohol abstinence in patients with alcohol dependence, and to identify the etiologic mechanism of alcohol dependence indirectly. METHODS: Plasma beta-endorphin, cortisol and ACTH level was measured in 14 alcohol dependent patients and in 14 healthy persons after 7 days and 28 days of alcohol abstinence at 08: 00h and 12: 00h, twice a day. RESULTS: 1) There was no significant difference in plasma beta-endorphin, cortisol and ACTH level measured at 08: 00h and 12: 00h between patients and control group after 7days of alcohol withdrawal. 2) Plasma beta-endorphin level measured at 08: 00h in patients was significantly elevated comparing with control group after 28days of alcohol withdrawal. But, there was no significant difference in plasma beta-endorphin level measured at 12: 00h and in plasma cortisol and ACTH level measured at both 08: 00h and 12: 00h between two groups after 28days of alcohol withdrawal. 3) In the patient group, there was no significant difference between patients after 7days and 28 days of alcohol withdrawal in plasma beta-endorphin, cortisol and ACTH level measured at 08: 00h and ACTH level measured at 12: 00h. But, beta-endorphin and cortisol level measured at 12: 00h were significantly lowered in patients after 28days of alcohol withdrawal than after 7days of withdrawal. 4) In decreasing rate of beta-endorphin production from 08: 00h to 12: 00h, there was significant difference between patients and controlled group after 28days of alcohol withdrawal. CONCLUSION: In alcohol dependent patients, lower level of beta-endorphin and increased reducing rate in diurnal variation of beta-endorphin after alcohol withdrawal are evident, which in turn may elevate craving for alcohol intake, and there findings support the opioid compensation theory in the development of alcohol dependence.
Adrenocorticotropic Hormone* ; Alcohol Abstinence ; Alcoholism ; Axis, Cervical Vertebra ; beta-Endorphin* ; Compensation and Redress ; Humans ; Hydrocortisone* ; Plasma*

The effect of a secretory proteinase from the pathogenic amoebae Acanthamoeba castellanii on hosts defense-oriented or regulatory proteins such as immunoglobulins, interleukin-1, and protease inhibitors was investigated. The enzyme was found to degrade secretory immunoglobulin A (sIgA), IgG, and IgM. It also degraded interleukin-1alpha (IL-1alpha) and IL-1beta. Its activity was not inhibited by endogenous protease inhibitors, such as alpha2-macroglobulin, alpha1-trypsin inhibitor, and alpha2-antiplasmin. Furthermore, the enzyme rapidly degraded those endogenous protease inhibitors as well. The degradation of hosts defense-oriented or regulatory proteins by the Acanthamoeba proteinase suggested that the enzyme might be an important virulence factor in the pathogenesis of Acanthamoeba infection.
Acanthamoeba/*enzymology/pathogenicity ; Animals ; Endopeptidases/*physiology ; Immunoglobulins/*metabolism ; Interleukin-1/*metabolism ; Protease Inhibitors/*metabolism ; Support, Non-U.S. Gov't ; Virulence