Prototheca wickerhamii is an achlorophyllic algae that rarely acts as an opportunistic pathogen in humans. We report the case of a 66-year-old female patient with a history of diabetes mellitus who presented with a pus-like discharge from face, facial redness, and swelling. The patient was admitted to the emergency room with worsening facial pain. Gram staining from pus-like discharge revealed yeast like features; however, an isolated colony on a blood agar plate was not identified using VITEK 2 (Biomerieux) or matrix-assisted laser desorption/ionization time-of flight mass spectrometry (MALDI-TOF) using VITEK MS (Biomerieux). Lactophenol cotton blue staining of the colony revealed characteristic sporangia and endospore features. After performing the protein extraction procedure for filamentous fungi (mold) isolates using ethanol and formic acid, MALDI-TOF MS identified the colony as Prototheca wickerhamii, with 99.9% confidence. This case indicates that Prototheca spp.require specialized sample preparation steps, such as the ethanol/formic acid extraction procedure, for identification using MALDI-TOF MS.

Prototheca wickerhamii is an achlorophyllic algae that rarely acts as an opportunistic pathogen in humans. We report the case of a 66-year-old female patient with a history of diabetes mellitus who presented with a pus-like discharge from face, facial redness, and swelling. The patient was admitted to the emergency room with worsening facial pain. Gram staining from pus-like discharge revealed yeast like features; however, an isolated colony on a blood agar plate was not identified using VITEK 2 (Biomerieux) or matrix-assisted laser desorption/ionization time-of flight mass spectrometry (MALDI-TOF) using VITEK MS (Biomerieux). Lactophenol cotton blue staining of the colony revealed characteristic sporangia and endospore features. After performing the protein extraction procedure for filamentous fungi (mold) isolates using ethanol and formic acid, MALDI-TOF MS identified the colony as Prototheca wickerhamii, with 99.9% confidence. This case indicates that Prototheca spp.require specialized sample preparation steps, such as the ethanol/formic acid extraction procedure, for identification using MALDI-TOF MS.

Prototheca wickerhamii is an achlorophyllic algae that rarely acts as an opportunistic pathogen in humans. We report the case of a 66-year-old female patient with a history of diabetes mellitus who presented with a pus-like discharge from face, facial redness, and swelling. The patient was admitted to the emergency room with worsening facial pain. Gram staining from pus-like discharge revealed yeast like features; however, an isolated colony on a blood agar plate was not identified using VITEK 2 (Biomerieux) or matrix-assisted laser desorption/ionization time-of flight mass spectrometry (MALDI-TOF) using VITEK MS (Biomerieux). Lactophenol cotton blue staining of the colony revealed characteristic sporangia and endospore features. After performing the protein extraction procedure for filamentous fungi (mold) isolates using ethanol and formic acid, MALDI-TOF MS identified the colony as Prototheca wickerhamii, with 99.9% confidence. This case indicates that Prototheca spp.require specialized sample preparation steps, such as the ethanol/formic acid extraction procedure, for identification using MALDI-TOF MS.

Prototheca wickerhamii is an achlorophyllic algae that rarely acts as an opportunistic pathogen in humans. We report the case of a 66-year-old female patient with a history of diabetes mellitus who presented with a pus-like discharge from face, facial redness, and swelling. The patient was admitted to the emergency room with worsening facial pain. Gram staining from pus-like discharge revealed yeast like features; however, an isolated colony on a blood agar plate was not identified using VITEK 2 (Biomerieux) or matrix-assisted laser desorption/ionization time-of flight mass spectrometry (MALDI-TOF) using VITEK MS (Biomerieux). Lactophenol cotton blue staining of the colony revealed characteristic sporangia and endospore features. After performing the protein extraction procedure for filamentous fungi (mold) isolates using ethanol and formic acid, MALDI-TOF MS identified the colony as Prototheca wickerhamii, with 99.9% confidence. This case indicates that Prototheca spp.require specialized sample preparation steps, such as the ethanol/formic acid extraction procedure, for identification using MALDI-TOF MS.

Prototheca wickerhamii is an achlorophyllic algae that rarely acts as an opportunistic pathogen in humans. We report the case of a 66-year-old female patient with a history of diabetes mellitus who presented with a pus-like discharge from face, facial redness, and swelling. The patient was admitted to the emergency room with worsening facial pain. Gram staining from pus-like discharge revealed yeast like features; however, an isolated colony on a blood agar plate was not identified using VITEK 2 (Biomerieux) or matrix-assisted laser desorption/ionization time-of flight mass spectrometry (MALDI-TOF) using VITEK MS (Biomerieux). Lactophenol cotton blue staining of the colony revealed characteristic sporangia and endospore features. After performing the protein extraction procedure for filamentous fungi (mold) isolates using ethanol and formic acid, MALDI-TOF MS identified the colony as Prototheca wickerhamii, with 99.9% confidence. This case indicates that Prototheca spp.require specialized sample preparation steps, such as the ethanol/formic acid extraction procedure, for identification using MALDI-TOF MS.

Merkel cell carcinoma is a rare aggressive primary skin cancer which mostly occurs in the elderly on sun-exposed skin. It usually presents as a solitary dome-shaped red or purple nodule on the head, neck and extremities. The mortality rate is higher than the rate for malignant melanoma because its local recurrence is common. Agent Orange, an herbicide widely used as a defoliant in the Vietnam War, contains dioxin contaminants and can cause several dermatoses and skin cancers. We report a case of multiple Merkel cell carcinoma in a 65-year-old male with lesions on the head and neck, who had been exposed to Agent Orange during Vietnam War.
2,4,5-Trichlorophenoxyacetic Acid ; 2,4-Dichlorophenoxyacetic Acid ; Aged ; Carcinoma, Merkel Cell ; Citrus sinensis ; Extremities ; Head ; Humans ; Male ; Melanoma ; Neck ; Recurrence ; Skin ; Skin Diseases ; Skin Neoplasms ; Tetrachlorodibenzodioxin ; Veterans ; Vietnam

BACKGROUND: The pericytes in the blood vessel wall have recently been identified to be important in regulating vascular formation, stabilization, remodeling, and function. We isolated and identified pericyte-like platelet-derived growth factor receptor beta-positive (PDGFRβ+) cells from the stromal vascular fraction (SVF) of adipose tissue from critical limb ischemia (CLI) patients and investigated their potential as a reliable source of stem cells for cell-based therapy. METHODS: De-identified subcutaneous fat tissues were harvested after amputation in CLI patients. Freshly isolated SVF cells and culture-expanded adipose-derived stem cells (ADSCs) were quantified using flow cytometry. A matrigel tube formation assay and multi-lineage differentiation were performed to assess pericytic and mesenchymal stem cell (MSC)-like characteristics of PDGFRβ+ ADSCs. RESULTS: PDGFRβ+ cells were located in the pericytic area of various sizes of blood vessels and coexpressed mesenchymal stem cell markers. PDGFRβ+ cells in freshly isolated SVF cells expressed a higher level of stem cell markers (CD34 and CXCR4) and mesenchymal markers (CD13, CD44, CD54, and CD90) than PDGFRβ– cells. In vitro expansion of PDGFRβ+ cells resulted in enrichment of the perivascular mesenchymal stem-like (PDGFRβ+/CD90+/CD45–/CD31–) cell fractions. The Matrigel tube formation assay revealed that PDGFRβ+ cells were located in the peritubular area. CONCLUSIONS: PDGFRβ+ ADSCs cells demonstrated a good multilineage differentiation potential. Pericyte-like PDGFRβ+ cells from the SVF of adipose tissue from CLI patients had MSC-like characteristics and could be amplified by in vitro culture with preservation of their cell characteristics. We believe PDGFRβ+ cells in the SVF of adipose tissue can be used as a reliable source of stem cells even in CLI patients.
Adipose Tissue ; Adipose Tissue, White* ; Adult Stem Cells ; Amputation ; Blood Vessels ; Extremities* ; Flow Cytometry ; Humans ; In Vitro Techniques ; Ischemia* ; Mesenchymal Stromal Cells ; Pericytes ; Platelet-Derived Growth Factor* ; Receptors, Platelet-Derived Growth Factor ; Stem Cells ; Subcutaneous Fat

Mycobacterium (M.) fortuitum is a rapidly growing mycobacterium. It is classified as Runyon's group IV with M. abcessus and M. chelonae that are mostly found in water and soil. M. fortuitum infection usually occurs after trauma, surgery or procedures such as acupuncture that cause cutaneous or soft tissue manifestations. We report a case of cutaneous infection due to M. fortuitum in a 72-year-old woman with erythematous deep-seated nodules on her left hand. She inflicted a minor injury to her left hand in a farm. Culture from skin biopsy specimens on 3% Ogawa medium yielded bacterial colonies after 5 days. The microorganism was subsequently identified as M. fortuitum by PCR-restriction fragment length polymorphism analysis. The skin lesions were improved by antibiotic therapy with clarithromycin for 6 months.
Acupuncture ; Aged ; Biopsy ; Clarithromycin ; Female ; Hand ; Humans ; Mycobacterium ; Mycobacterium fortuitum ; Skin ; Soil

BACKGROUND: Korea set up new diagnosis related group (DRG) as demonstration project in 2009. The new DRG was reformed in 2016. The main purpose of study is to identify the effect of reform on accuracy of payment. METHODS: This study collected inpatient data from a hospital which contains medical information and cost from 2015 to 2016. The dependent variables were accuracy of total, bundled, unbundled payment, and payment for procedures. To analyze the effect of reform, this study conducted a multi-variate regression analysis adjusting for confounding variables. RESULTS: The accuracy of payment increased after policy reform. The accuracy of total, bundled, unbundled payment, and payment for procedures significantly increased 3.90%, 2.92%, 9.03%, and 14.57% after policy reform, respectively. The accuracy of unbundled payment showed the largest increase among dependent variables. CONCLUSION: The results of study imply that policy reform enhanced the accuracy of payment. The government needs to monitor side effects such as increase of non-covered services. Also, leads to a considerable improvement in the value of cost unit accounting as a strategic play a role in development of DRG.
Confounding Factors (Epidemiology) ; Diagnosis ; Diagnosis-Related Groups ; Humans ; Inpatients ; Korea

BACKGROUND: Korea set up new diagnosis related group (DRG) as demonstration project in 2009. The new DRG was reformed in 2016. The main purpose of study is to identify the effect of reform on accuracy of payment. METHODS: This study collected inpatient data from a hospital which contains medical information and cost from 2015 to 2016. The dependent variables were accuracy of total, bundled, unbundled payment, and payment for procedures. To analyze the effect of reform, this study conducted a multi-variate regression analysis adjusting for confounding variables. RESULTS: The accuracy of payment increased after policy reform. The accuracy of total, bundled, unbundled payment, and payment for procedures significantly increased 3.90%, 2.92%, 9.03%, and 14.57% after policy reform, respectively. The accuracy of unbundled payment showed the largest increase among dependent variables. CONCLUSION: The results of study imply that policy reform enhanced the accuracy of payment. The government needs to monitor side effects such as increase of non-covered services. Also, leads to a considerable improvement in the value of cost unit accounting as a strategic play a role in development of DRG.
Confounding Factors (Epidemiology) ; Diagnosis ; Diagnosis-Related Groups ; Humans ; Inpatients ; Korea