Orientia tsutsugamushi, a causative pathogen of Scrub typhus, is a gram-negative intracellular bacterium. Outer membrane vesicles (OMVs) are produced from the membrane of bacteria and play many roles related to the survival of the pathogen. However, there have been no reports confirming whether O. tsutsugamushi indeed produce OMVs. O. tsutsugamushi boryong was cultured in ECV-304 cells for the purification of OMVs. Western blot analysis and immunoenrichment using anti-O. tsutsugamushi monoclonal antibody and electron microscopy were employed for identification and characterization of OMVs. We confirm the presence of OMVs derived from O. tsutsugamushi, and also found that those OMVs contain a major surface antigen of 56-kDa protein and variant immunogenic antigens.
Antibodies, Monoclonal/*immunology ; Antigens, Bacterial/*immunology ; Antigens, Surface/*immunology ; Cell Line ; Cell Membrane/immunology ; Humans ; Microscopy, Electron ; Orientia tsutsugamushi/*immunology/metabolism ; Scrub Typhus/diagnosis/microbiology ; Secretory Vesicles/*immunology

BACKGROUND: Spinal cord ischemic injury occurring after surgical repair of thoracoabdominal aortic disease leaves a devastating complication. The purpose of this study was to evaluate the effects of anesthetic preconditioning on neurologic outcome and Bcl-2 family protein gene expression in transient spinal ischemia. METHODS: In first experiment rats were divided by 4 groups and anesthetized with intraperitoneal propofol, enflurane, sevoflurane, or isoflurane. In second experiment, all rats were anesthetized with intraperitoneal propofol and enflurane, sevoflurane, isoflurane were given during 30 minutes and 14 minutes of spinal ischemia was induced 30 minutes later. Spinal ischemia was produced by both induced hypotension and thoracic aortic cross clamping. Neurologic scores were assessed 1, 3, 24, 48 hours after transient spinal ischemia. After 48 hours, rats were killed under anesthesia and spinal cords were removed for the assay of Bcl-2 family protein mRNA expression. RESULTS: The neurologic injury of S and I group were significantly lesser than P group. 30 minutes of anesthetic preconditioning with enflurane, sevoflurane, and isoflurane showed significantly better neurologic outcome compared to propofol, enflurane, sevoflurane, or isoflurane anesthetized rats. Bcl-2 family protein mRNA expression of I group and IP group were lesser than the other groups. CONCLUSIONS: Anesthetic preconditioning with volatile anesthetics for 30 minutes could reduce ischemic injury during transient spinal ischemia. The degree of neurologic injury may not be related to the expression of pro-apoptotic protein Bax. Isoflurane may have different influence on apoptosis after spinal ischemia compared to enflurane or sevoflurane.
Anesthesia ; Anesthetics ; Anesthetics, Inhalation ; Animals ; Aortic Diseases ; Apoptosis ; Constriction ; Enflurane ; Gene Expression ; Humans ; Hypotension ; Ischemia* ; Isoflurane ; Propofol ; Rats* ; RNA, Messenger* ; Spinal Cord ; Spinal Cord Ischemia

BACKGROUND: Spinal cord ischemic injury occurring after surgical repair of thoracoabdominal aortic disease leaves a devastating complication. The purpose of this study was to evaluate the effects of anesthetic preconditioning on neurologic outcome and Bcl-2 family protein gene expression in transient spinal ischemia. METHODS: In first experiment rats were divided by 4 groups and anesthetized with intraperitoneal propofol, enflurane, sevoflurane, or isoflurane. In second experiment, all rats were anesthetized with intraperitoneal propofol and enflurane, sevoflurane, isoflurane were given during 30 minutes and 14 minutes of spinal ischemia was induced 30 minutes later. Spinal ischemia was produced by both induced hypotension and thoracic aortic cross clamping. Neurologic scores were assessed 1, 3, 24, 48 hours after transient spinal ischemia. After 48 hours, rats were killed under anesthesia and spinal cords were removed for the assay of Bcl-2 family protein mRNA expression. RESULTS: The neurologic injury of S and I group were significantly lesser than P group. 30 minutes of anesthetic preconditioning with enflurane, sevoflurane, and isoflurane showed significantly better neurologic outcome compared to propofol, enflurane, sevoflurane, or isoflurane anesthetized rats. Bcl-2 family protein mRNA expression of I group and IP group were lesser than the other groups. CONCLUSIONS: Anesthetic preconditioning with volatile anesthetics for 30 minutes could reduce ischemic injury during transient spinal ischemia. The degree of neurologic injury may not be related to the expression of pro-apoptotic protein Bax. Isoflurane may have different influence on apoptosis after spinal ischemia compared to enflurane or sevoflurane.
Anesthesia ; Anesthetics ; Anesthetics, Inhalation ; Animals ; Aortic Diseases ; Apoptosis ; Constriction ; Enflurane ; Gene Expression ; Humans ; Hypotension ; Ischemia* ; Isoflurane ; Propofol ; Rats* ; RNA, Messenger* ; Spinal Cord ; Spinal Cord Ischemia

BACKGROUND: Midazolam or propofol has been used for the procedural sedation in children. However, the combined use of remifentanil have not been widely investigated. The purpose of this study was to evaluate the effectiveness and safety of remifentanil infusion with intravenous anesthetics during the central venous catheterization in children. METHODS: After institutional review board approval and written informed consent from patients' parent, 20 children planned central venous catheterization for chemotherapy were randomly assigned into two groups. All patients were infused with remifentanil 0.1microng/kg/min. In M group, 0.3 mg/kg of midazolam bolus was injected and 0.1 mg/kg bolus were injected intermittently if the sedation was inadequate. In P group, 1.0 mg/kg of propofol bolus and 150microng/kg/min were infused. 0.5 mg/kg of propofol was given intermittently if the sedation was inadequate. Hemodynamic variables, end-tidal CO2 (EtCO2), bispectral index score (BIS) were monitored throughout the procedure. RESULTS: There were no significant differences in hemodynamic variables, sedation and recovery times. Oxygen saturation (SpO2) in P group was significantly lower than that of M group at 15 min after the start of infusion. EtCO2 in P group was significantly higher than that of M group at 10 min after the start of infusion. Hypoxemia (SpO2< 90%) were occurred in three patients of P group. There was no significant difference in BIS among the groups. CONCLUSIONS: The combined infusion of remifentanil 0.1microng/kg/min with midazolam provided successful sedation without airway assistance during the central venous catheterization in children.
Anesthetics, Intravenous ; Anoxia ; Catheterization, Central Venous* ; Central Venous Catheters* ; Child* ; Drug Therapy ; Ethics Committees, Research ; Hemodynamics ; Humans ; Informed Consent ; Midazolam* ; Oxygen ; Parents ; Propofol*

OBJECTIVE: To translate the MD Anderson Dysphagia Inventory (MDADI) which is a self-administered questionnaire that assesses effect of dysphagia on the quality of life for patients with head and neck cancer, into Korean and to verify the validity and reliability of the Korean version of MDADI. METHODS: We performed 6 steps for the cross-cultural adaptation which consisted of translation, synthesis, back translation, review by an expert committee, cognitive debriefing, and final proof reading. A total of 34 dysphagia patients with head and neck cancers from Seoul National University Hospital answered the translated version of the questionnaire for the pre-testing. The patients answered the same questionnaire 2 weeks later to verify the test-retest reliability. RESULTS: One patient was excluded at second survey because he changed his feeding strategy. Overall, 33 patients completed the study. Linguistic validations were achieved by each step of cross-cultural adaptation. We gathered statistically strong construct validity (Spearman rho for subdomain scores to total score correlation range from 0.852 to 0.927), internal consistency for subdomains (Cronbach's alpha coefficients range from 0.785 to 0.889) and test-retest reliability (intra-class correlation coefficient range from 0.820 to 0.955) CONCLUSION: The Korean version of the MDADI achieved linguistic validations and demonstrated good construct validity and reliability. It can be a useful tool for screening and treatment planning for the dysphagia of patients with head and neck cancers.
Deglutition Disorders ; Head ; Head and Neck Neoplasms ; Humans ; Linguistics ; Mass Screening ; Neck ; Quality of Life ; Reproducibility of Results ; Surveys and Questionnaires

Deep sedation or general anesthesia has been frequently required daily radiation therapy in pediatric patients. We experienced repeated sedation with propofol in a 16-year-old patient who underwent consecutive radiation therapy due to brain tumor. During treatment, the patient showed increased susceptibility to propofol. The brain magnetic resonance imaging (MRI) showed gradual increase in size of brain tumor regardless of radiation therapy. The increased susceptibility of propofol may be related with growth of brain tumor.
Adolescent ; Anesthesia, General ; Brain Neoplasms* ; Brain* ; Deep Sedation ; Humans ; Magnetic Resonance Imaging ; Propofol*

No abstract available.
Paralysis* ; Spondylitis*

Transradial access is a widely accepted method for percutaneous coronary diagnostic and interventional procedures, and it has dramatically reduced access site vascular complications compared to transfemoral access. Arteriovenous fistula formation at the access site is an especially rare complication in transradial access. We report an extremely rare case of delayed radial arteriovenous fistula that developed one year after transradial coronary angiography, which was successfully treated by surgical repair.
Angiography ; Arteriovenous Fistula ; Cardiac Catheterization ; Coronary Angiography ; Vascular Diseases

BACKGROUND: In this study we estimated the prevalence of cardiovascular (CV) risk factors according to waist-to- height ratio (W/Ht ratio) in adult obese women to ensure the importance of abdominal obesity and determined the usefulness of W/Ht ratio as a index of abdominal obesity in adult obese women. METHODS: The study subjects were 190 adult obese women who visited an obesity clinic from August, 2001 to January, 2003. They were divided into 4 groups: Group 1; BMI<30, W/Ht<0.6, Group 2; BMI<30, W/Ht> or =0.6, Group 3; BMI> or =30, W/Ht<0.6, and Group 4; BMI> or =30, W/Ht> or =0.6. In each group, we compared the prevalence and odds ratio for CV risk factors. RESULTS: In obese group, the prevalence of high blood glucose (P<0.01), hypertriglyceridemia (P<0.01) were significantly higher in group 2 than group 1. In high obese group, the prevalence of systolic hypertension (P<0.01), high blood glucose (P<0.01), hypercholesterolemia (P<0.01), hypertriglyceridemia (P<0.05), and high LDL-cholesterol were significantly higher in group 4 than group 3. When odds ratio for each group with reference to group 1 were compared after adjusting for age, high blood glucose (4.48), and hypertriglyceridemia (6.10) in group 2, and systolic hypertension (2.69), high blood glucose (3.02), and hypertriglyceridemia (4.00) in group 4 were significantly higher. CONCLUSION: The prevalence of CV risk factors were likely to be increased in higher W/Ht group independently to BMI. W/Ht ratio can be a simple, useful index for abdominal obesity and its related risk factors not only in adult males but also in adult obese women.
Adult ; Blood Glucose ; Body Mass Index ; Cardiovascular Diseases* ; Female ; Humans ; Hypercholesterolemia ; Hypertension ; Hypertriglyceridemia ; Male ; Obesity ; Obesity, Abdominal ; Odds Ratio ; Prevalence ; Risk Factors*

It can be difficult for clinicians to distinguish a paradoxical response to antituberculous therapy, worsening of an existing lesion despite adequate treatment, treatment failure, and drug resistance. We report a case of a 69-year-old woman who experienced bilateral lower extremity paralysis secondary to a paradoxical response. She had been suffering for 1 month from low back pain, due to tuberculous spondylitis. Her low back pain improved after antituberculous therapy. The low back pain, however, reappeared 2 months after treatment, accompanied by newly developed lower extremity weakness. Imaging studies showed an increased extent of her previous lesions. Consequently, the patient underwent a vertebral corpectomy with interbody fusion of the thoracolumbar spine. Histopathological examination showed chronic inflamed granulation tissue with no microorganisms. Although the antituberculous medication was not changed, the patient's symptoms and signs, including the paralysis, resolved after surgery.
Aged ; Drug Resistance ; Female ; Granulation Tissue ; Humans ; Low Back Pain ; Lower Extremity ; Paralysis* ; Spine ; Spondylitis* ; Treatment Failure ; Tuberculosis, Spinal