BACKGROUND: The incidence of candidemia has increased, and an early differentiation of transient or central venous catheter (CVC)-related candidemia from deep-seated invasive candidiasis is often difficult. The Pastorex Candida antigen assay (Sanofi Diagnostics Pasteur, Marnes-la-Coquette, France) is known to be an useful and specific tool for the diagnosis of invasive candidiasis. We assessed the clinical significance of Pastorex Candida antigen assay in patients with candidemia. METHODS: Eighty-five sera from 27 patients with candidemia and 42 control sera (32 patients with superficial Candida colonization and 10 healthy subjects) were tested. The Pastorex Candida latex agglutination test was performed to evaluate the presence of Candida mannan antigen. Candidemia was divided into 3 categories; (i) transient, (ii) CVC-related, and (iii) non-CVC-related persistent types. RESULTS: Thirty-two patients with superficial Candida colonization and 10 healthy subjects were negative for the Pastorex Candida antigen. Of the 85 sera from 27 patients with candidemia, 14 (16.4%) were positive for the Pastorex Candida antigen. The Pastorex Candida antigen was detected neither in 6 patients with transient candidemia nor 15 patients with CVC-related candidemia. Conversely, it was detected in at least one serum sample of 5 of the 6 (83.3%) patients with non-CVC-related persistent candidemia. Of the 24 sera from 6 patients with non-CVC-related persistent candidemia, 14 (58.3%) were positive for the Pastorex Candida antigen. Overall, the sensitivity and specificity of the Pastorex Candida antigen assay for the diagnosis of non-CVC-related persistent candidemia were 83.3% and 100%, respectively. CONCLUSIONS: Our data suggest that the Pastorex Candida antigen assay has a potential for the differential diagnosis of non-CVC-related persistent candidemia from transient or CVC-related candidemia.
Candida* ; Candidemia* ; Candidiasis, Invasive ; Central Venous Catheters ; Colon ; Diagnosis ; Diagnosis, Differential ; Humans ; Incidence ; Latex Fixation Tests ; Mannans ; Sensitivity and Specificity

BACKGROUND: Telomerase activity in precancerous conditions of lung adenocarcinomas has not been well studied. This study is designed to investigate the role of telomerase in premalignant lesions of urethane-induced mouse lung adenocarcinoma. METHODS: We harvested A/J mouse lung tissues at 3, 6, 9, 12, 28, 41, and 48 weeks after intraperitoneal urethane treatment, and classified each lesion in terms of histologic findings. We examined telomerase activity using a modified version of the telomeric repeat amplification protocol assay using both gel-based and enzyme linked immunosorbent assay methods. An immunohistochemical analysis of proliferating cell nuclear antigen (PCNA) was performed. RESULTS: In urethane-induced mouse lung tissues, it was sequentially developed from hyperplasia, adenoma, and eventually to adenocarcinoma. Telomerase activity began to show a positive level in tissues with no histologically visible nodule after urethane administration. It revealed a statistically significant increase in hyperplasia compared to the "control" lung tissue (p<0.05), which was proportionally elevated relative to adenoma and adenocarcinoma. There was a direct correlation between telomerase activity and the PCNA labeling index (p<0.05). CONCLUSIONS: The elevation of telomerase activity in normal-appearing lung lesions is thought to be a possible marker of early detection of pulmonary adenocarcinoma.
Adenocarcinoma ; Adenoma ; Animals ; Cell Transformation, Neoplastic ; Enzyme-Linked Immunosorbent Assay ; Hyperplasia ; Lung ; Mice ; Precancerous Conditions ; Proliferating Cell Nuclear Antigen ; Telomerase ; Urethane

BACKGROUND: BACTEC MGIT 960 system(Becton Dickinson, USA; MGIT 960) is a fully automated, noninvasive culture system for mycobacteria, which has been regarded as a sensitive and least labor-intensive method. This study was purposed to evaluate the performance of MGIT 960 compared to BACTEC 460 TB radiometric system(Becton Dickinson, USA; BACTEC 460) and Ogawa media. METHODS: A total of 1,067 clinical specimens submitted from April to June in 1999 was cultured for acid fast bacilli(AFB). All specimens were digested, decontaminated by the 6% sodium hydroxide(final concentration of 1.5%) and 0.5% N-acetyl-L-cysteine method. All specimens were inoculated into three kinds of media: a MGIT, a BACTEC 12B, and an Ogawa medium. The AFB recovered from cultures were identified to M. tuberculosis complex and MOTT by NAP test. RESULTS: Of 106 isolates of M. tuberculosis recovered from all culture systems, 101(95.3 %) were detected in the MGIT 960, 95(89.6%) in the BACTEC 460 and 76(71.7%) on Ogawa media. MGIT 960 plus Ogawa media detected 104(98.1%) isolates and BACTEC 460 plus Ogawa media recovered 96(90.6%) isolates. The mean time required for detection of M. tuberculosis was 12.7+/-5.8 days with MGIT 960, 16.2+/-7.7 days with BACTEC 460, and 22.8+/-9.5 days with Ogawa media. The contamination rate were 5.1% for MGIT 960, 2.7% for BACTEC 460, and 6.7% for Ogawa media. CONCLUSIONS: MGIT 960 is a sensitive and rapid method to isolate M. tuberculosis.
Acetylcysteine ; Mycobacterium tuberculosis* ; Mycobacterium* ; Sodium ; Tuberculosis

BACKGROUND: Minimum inhibitory concentration (MIC) endpoint determination is the major varia-tion source for the fluconazole susceptibility test, especially for Candida albicans. In this study, we evaluated spectrophotometric broth microdilution methods using RPMI 1640 and RPMI supple-mented with 18 g of glucose per liter (RPMI-2% glucose) for determining fluconazole susceptibility of C. albicans. METHODS: A total of 129 clinical isolates of C. albicans were tested by the broth microdilution method using RPMI and RPMI-2% glucose. The MIC endpoint was calculated objectively with the spectrophotometer set at 405 nm. These results were compared to those by the National Commit-tee for Clinical Laboratory Standards (NCCLS) macrodilution method and the agar dilution method. RESULTS: The mean absorbances in the drug-free wells in RPMI and RPMI-2% glucose were 0.208 +/- 0.014 and 0.316 +/- 0.061, respectively, at 24 h and 0.339 +/- 0.094 and 0.530 +/- 0.104, respectively, at 48 h (P < 0.01). The agreement of the microdilution method with the RPMI within two doubling dilutions of the macrodilution reference were 91.5% (118/129) at 24 h and 76.7% (99/129) at 48 h. The percentage of agreement in the microdilution method with the RPMI-2% glucose were significantly higher: 100% (129/129) at 24 h and 99.2% (128/129) at 48 h (P < 0.01). In addition, the MIC endpoints were easier to detect in RPMI-2% glucose, because of the greater difference in absorbance in between grown wells and fluconazole-inhibited wells (P < 0.01). CONCLUSIONS: The spectrophotometric microdilution method with RPMI-2% glucose may have an excellent agreement with the NCCLS broth macrodilution method and may provide more easily determined MIC endpoints for fluconazole susceptibility testing for C. albicans.
Agar ; Candida albicans* ; Candida* ; Endpoint Determination ; Fluconazole* ; Glucose* ; Microbial Sensitivity Tests

BACKGROUND: Multidisciplinary team care (MTC) is a collaborative approach to treatment plan and ongoing care. We aimed to evaluate the clinical effect of MTC on the regulation of chronic kidney disease-mineral and bone disorder (CKD-MBD) complications in dialysis patients. METHODS: This retrospective observational study was approved by the institutional review board. Among patients who have undergone dialysis at admission, the patients admitted to the nephrology ward were allocated to MTC group, and the others to usual care (UC) group. The MTC group had collaborative care by nephrologists, nurses, pharmacists, and nutritionists. The endpoints were the regulation of corrected calcium (cCa) and phosphate (P), the percent of patients in target level of cCa-P product (cCa×P), and the prescription rate of non-calcium based P-binders. RESULTS: A total of 163 patients were included from January to December 2009. A significant difference was shown in the percentage of patients in target cCa×P level at admission (MTC vs. UC, 81.40% vs. 91.67%; P = 0.038), but there was no significant difference at discharge. During admission, the cCa and P levels of patients in only UC group were significantly changed. In addition, compared with UC group, patients in MTC group were more likely prescribed appropriate P-binders, when they had higher cCa×P levels than 55 mg²/dL² (P <0.001). CONCLUSION: It was found that MTC had beneficial effect on improving the regulation of CKD-MBD and the appropriate phosphate binder uses. Therefore, application of the MTC is anticipated to enhance quality of clinical care in chronic diseases.
Calcium ; Chronic Disease ; Dialysis* ; Ethics Committees, Research ; Humans ; Kidney ; Miners* ; Nephrology ; Nutritionists ; Observational Study ; Pharmacists ; Prescriptions ; Renal Insufficiency, Chronic* ; Retrospective Studies

BACKGROUND: Although the broth microdilution method has been recently established for antifungal susceptibility testing of the Candida species, there is still an argue in the interpretation of the trailing endpoint. We evaluated the spectrophotometric broth microdilution method (SBM) to determine the fluconazole MICs from five different Candida species. METHODS: A total of 252 clinical isolates of five Candida species (144 C. albicans, 42 C. tropicalis, 32 C. glabrata, 28 C. parapsilosis, and 6 C. krusei) were tested for fluconazole susceptibility with the broth microdilution method. The MICs were spectrophotometrically determined at 80% (Spec-80%) and 50% (Spec-50%) decrease in absorbance as compared with growth control, respectively. The results were compared with the fluconazole MICs tested by the National Committee for the Clinical Laboratory Standards (NCCLS) macrodilution method. RESULTS: When MICs were obtained by Spec-80%, the agreements of SBM and the NCCLS macro dilution method within two doubling dilutions were 92.4% (220/238) at 24 h and 78.6% (198/252) at 48 h for all Candida species. Using the Spec-50%, those were increased to 97.9% (233/238) at 24 h and 98.8% (249/252) at 48 h (P<0.01). Especially, for C. albicans and C. tropicalis, the agreement of the Spec-50% was significantly higher than those of the Spec-80% at 48 h; 97.9% vs. 75.0%, for C. albicans (P<0.01), and 100% vs. 57.1%, for C. tropicalis (P<0.01). CONCLUSIONS: These data suggest that the SBM using Spec-50% can provide a more precise and objective mean for fluconazole susceptibility testing, especially for C. albicans and C. tropicalis.
Candida albicans ; Candida* ; Fluconazole*

Congenital myotonic dystrophy is a severe and early-onset form of myotonic dystrophy (DM) with a prevalence of 2.5-5.5/100,000 live births. Expansion of the trinucleotide CTG repeat in the 3 untranslated region of the DM gene, which is located at a chromosome 19q13.3 is a common mutation in DM. Clinical features are generalized hypotonia (floppy infant), respiratory and feeding difficulty, and the neonatal mortality rate is approximately 40%. We experienced a case of recurrent congenital myotonic dystrophy, and report with a review of related literatures. Women with recurrent neonatal hypotonia or ultrasonographic evidence of hypotonia, including positional abnormalities of the extremities and idiopathic polyhydramnios, should be offered testing for the genetic studies for myotonic mutation, such as PCR (Polymerase chain reaction) analysis and Southern blot analysis.
Blotting, Southern ; Diagnosis* ; Extremities ; Female ; Humans ; Infant ; Infant Mortality ; Live Birth ; Muscle Hypotonia ; Myotonic Dystrophy* ; Polyhydramnios ; Polymerase Chain Reaction ; Prenatal Diagnosis ; Prevalence ; Untranslated Regions

Congenital myotonic dystrophy is a severe and early-onset form of myotonic dystrophy (DM) with a prevalence of 2.5-5.5/100,000 live births. Expansion of the trinucleotide CTG repeat in the 3 untranslated region of the DM gene, which is located at a chromosome 19q13.3 is a common mutation in DM. Clinical features are generalized hypotonia (floppy infant), respiratory and feeding difficulty, and the neonatal mortality rate is approximately 40%. We experienced a case of recurrent congenital myotonic dystrophy, and report with a review of related literatures. Women with recurrent neonatal hypotonia or ultrasonographic evidence of hypotonia, including positional abnormalities of the extremities and idiopathic polyhydramnios, should be offered testing for the genetic studies for myotonic mutation, such as PCR (Polymerase chain reaction) analysis and Southern blot analysis.
Blotting, Southern ; Diagnosis* ; Extremities ; Female ; Humans ; Infant ; Infant Mortality ; Live Birth ; Muscle Hypotonia ; Myotonic Dystrophy* ; Polyhydramnios ; Polymerase Chain Reaction ; Prenatal Diagnosis ; Prevalence ; Untranslated Regions