BACKGROUND: Nineteen strains of Shigella sonnei isolated from the patients were examined regarding their biochemical characterization, serotype, and antibiotics resistance, and then analyzed for plasmid DNA profile. METHODS: Strains were tested for possession of set1A, set1B, sen, ipaH, ial, stx and invE genes using the polymerase chain reaction (PCR) method and were analyzed using the pulsed-field gel electrophoresis (PFGE) pattern against 7 outbreak isolates (10 strains). RESULTS: These strains had the typical biochemical characterization of S. sonnei with positive ornithine decarboxylase and -galactosidase activity, but were negative in mannitol fermentation. Serotype were identified as the I phase in 13 strains (68.0%) and the II phase in 6 strains (32.0%). All strains were resistant to erythromycin, vancomycin, tetracycline, and penicillin. The antibiogram type showed 4 groups from I to IV. The strains showed 8 types of plasmid profiles and were designated as P1 to P8. By the PCR, the ipaH gene and the set1B gene were detected from all of the 16 strains. The invE was detected from 9 strains (56.3%), and the sen gene was detected from 5 strains. All strains were negative for the Stx and the set1A gene. High-molecular-weight genomic DNA was prepared from 7 outbreak isolates (10 strains) and digested with the restriction endonuclease XbaI. Restriction fragment patterns of chromosomal DNA were demonstrated by PFGE. XbaI produced about 23 fragments in all strains with the their size ranged from 40 to 680 kb. Ten strains could be differentiated to 3 patterns by chromosomal DNA fingerprint. CONCLUSIONS: All of the Shigella sonnei strains that were isolated from Busan Province showed similar chromosomal DNA fragment patterns, while the Japanese differed in chromosomal DNA fingerprint pattern. PFGE is useful for the epidemiological study of Shigella sonnei associated endemic diarrhea.
Anti-Bacterial Agents ; Asian Continental Ancestry Group ; Busan ; Diarrhea ; DNA ; DNA Fingerprinting ; DNA Restriction Enzymes ; Electrophoresis, Gel, Pulsed-Field ; Erythromycin ; Fermentation ; Genotype ; Humans ; Mannitol ; Microbial Sensitivity Tests ; Ornithine Decarboxylase ; Penicillins ; Plasmids ; Polymerase Chain Reaction ; Shigella sonnei* ; Shigella* ; Tetracycline ; Vancomycin ; Virulence Factors* ; Virulence*

BACKGROUND: Most of the shigellosis outbreaks in Korea have been caused by Shigella sonnei since late 1990's. We analyzed 36 strains of S. sonnei isolated in South Korea from 1998 to 2001 by molecular epidemiologic tools to understand genetic relationship of the outbreaks. METHODS: The 36 strains of S. sonnei were tested for the presence of virulence genes (ial, ipaH, stx, set1A, set1B and sen) using polymerase chain reaction (PCR) method and for the production of Shiga-toxin using latex agglutination test. Seventeen representative strains were selected and their genetic relevance was analyzed by plasmid profile and pulsed-field gel electrophoresis(PFGE). RESULTS: By PCR, ipaH gene was detected in all 36 strains, set1B gene in 15 strains (41.7%), and sen gene in 16 strains (44.4%); all strains were negative for set1A gene. Although stx gene was positive in four strains by PCR method, the toxin was negative by latex agglutination test. The strains were differentiated into 11 groups by plasmid profile and 1 type with 3 subtypes (A-1, A-2and A-3) by PFGE. CONCLUSION: There was a wide range of diverse virulence genes present in the outbreak strains of S. sonnei. PFGE analysis indicated that all the strains tested were related with each other despite minor genotypic and phenotypic differences. A genetically identical clone of S. sonnei was estimated to be the cause of the outbreaks.
Clone Cells ; Disease Outbreaks ; Dysentery, Bacillary ; Genotype ; Korea* ; Latex Fixation Tests ; Molecular Epidemiology* ; Plasmids ; Polymerase Chain Reaction ; Shigella sonnei* ; Shigella* ; Virulence Factors* ; Virulence*

BACKGROUND: Salmonella enterica serovars often have a broad host range and cause some gastrointestinal and systemic diseases. The diagnosis of typhoid fever or paratyphoid fever is made by ordinary culture methods and biochemical tests. However, a more rapid and alternative method of diagnosing these diseases is in need since the classical diagnostic method requires several days for a result. Some researchers have already reported serovar Typhi detection methods with PCR using the fliC-d gene and the Vi capsular antigen gene. METHODS: Thirty-six Salmonella strains isolated at Pusan National University Hospital from 1997 to 2004 were used for a rapid identification of S. enterica serovars Typhi and Paratyphi A with multiplex PCR that uses the O (rfbE, rfbS), H (fliC-d, fliC-a), and Vi (viaB) antigen genes. To further characterize these Salmonella strains, we used PCR to detect genes (invA and enterotoxin) for proposed virulence factors and performed antimicrobial susceptibility testing, serotyping and pulsed-field gel electrophoresis for epidemiological characteristics. RESULTS: Most strains were resistant to ampicillin. By PCR, tyv, prt, fliC-d and viaB genes were detected in serovar Typhi, whereas only fliC-a and prt genes were found in serovar Paratyphi A. In addition, invA and enterotoxin genes were detected in both strains. CONCLUSION: This method enabled us to identify and differentiate serovars Typhi and Paratyphi A by only a single PCR assay. That is, clinically important human pathogens were more rapidly and specifically detected and identified with multiplex PCR.
Ampicillin ; Busan ; Diagnosis ; Electrophoresis, Gel, Pulsed-Field ; Enterotoxins ; Genotype ; Host Specificity ; Humans ; Multiplex Polymerase Chain Reaction* ; Paratyphoid Fever ; Polymerase Chain Reaction ; Salmonella enterica* ; Salmonella* ; Serotyping ; Typhoid Fever ; Virulence Factors

Armeniacae semen (AS) has been considered a toxic herb in the Korean medicine as it contains hydrogen cyanide and amygdalin, especially in its endocarp. Therefore, prebrewed AS that is devoid of endocarp has been traditionally used. In the present study, amygdalin content of the prebrewed AS was significantly lower (2.73 +/- 0.32 microg/ml; p < 0.01) than the content in the extract that contained the endocarps (28.50 +/- 6.71 microg/ml); amygdalin content corresponded to 10% of the extract in the present study. Because of single oral dose toxicity of prebrewed AS according to the recommendation of Korea Food and Drug Administration Guidelines (2009-116, 2009), which was based on single oral dose toxicity study of prebrewed AS, mortality due to toxic principles was significantly reduced. In this study, 2,000 mg/kg of prebrewed AS led to death of 1 female rat and 1 male rat at the end of 2 hr of administration. Based on these results, the 50% lethal dose in both male and female rats was determined to be 9279.5 mg/kg. Seizure, loss of locomotion, and increases in respiration and heart rate were observed as prebrewed AS treatment-related toxicological signs; these signs were restrictedly manifested in the prebrewed AS (2,000 mg/kg)-treated rats. In addition, no changes were observed in body weight, organ weight, gross features, and histopathological parameters with 2,000 mg/kg of AS in both male and female rats. These findings serve as direct evidence that amygdalin in AS is the toxic principle, which can be reduced by the traditional prebrewing method involving the exclusion of endocarp.
Amygdalin ; Animals ; Body Weight ; Female ; Heart Rate ; Humans ; Hydrogen Cyanide ; Korea ; Locomotion ; Male ; Organ Size ; Rats ; Respiration ; Seizures ; Semen ; United States Food and Drug Administration

Arterial remodeling is commonly observed in human atherosclerosis. It is a heterogeneous response ranging from positive remodeling to negative remodeling. Negative remodeling is a condition in which the vessel area decreases in size, often as a result of a structural change in the coronary vessel wall. But its contribution to myocardial ischemia in a de novo lesion has not been clearly shown. A 51-year-old female with exertional angina was admitted to our hospital. Coronary angiography was performed, revealing a severe stenosis at the middle part of the right coronary artery (RCA). Although we predilated ballooning at the middle RCA, the degree of stenosis did not improve. Thus intravascular ultrasound (IVUS) was performed. The lesion was not nearly showed plaque burden and severe negative remodeling. Though the cross-sectional narrowing percentage was significant, we decided to medical treatment for fearing coronary perforation by stenting. This case report intends to emphasize that severe coronary stenosis should be performed IVUS before the stenting. We describe a rare case with severe negative remodeling at the middle part of the RCA without atheroma plaque.
Atherosclerosis ; Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis ; Coronary Vessels ; Female ; Glycosaminoglycans ; Humans ; Myocardial Ischemia ; Plaque, Atherosclerotic ; Stents

OBJECTIVE: The aim of this study was to investigate the interpersonal violence (IPV) epidemiology and mortality according to the violence victim-perpetrator relationships. METHODS: A retrospective cross-sectional study was done using the comprehensive data of the emergency department (ED)-based Jeju Injury Surveillance System from all EDs in Jeju Island. The demographic characteristics of the victims, the types of perpetrators (spouse, family members, acquaintance, and stranger), injury characteristics and clinical outcomes from the injury were collected. The IPV epidemiology was reported by descriptive statistics. Multivariate Poisson regression was used to analyze the association between the mortality and violence victim-perpetrator relationships. RESULTS: Among the 23,508 violent injury patients enrolled from January 1, 2008, and December 31 of 2016, 19,879 (84.6%) were analyzed; 16 (0.08%) died at the ED. The types of perpetrators were the spouse (10.1%), family members (3.9%), acquaintances (43.4%), and strangers (42.7%). The mortality of the violence victims was increased significantly by the spouse (incidence rate ratio [IRR], 6.336; P=0.043) or family members (IRR, 11.089; P=0.016) compared to strangers. On the other hand, there was no difference between the acquaintances and strangers. CONCLUSION: The epidemiology and mortality of IPV were associated with the violence victim-perpetrator relationships. Therefore, it is necessary to develop and apply prevention programs considering these differences, particularly for intimidate/ family violence because of its high fatality.
Cross-Sectional Studies ; Domestic Violence ; Emergency Service, Hospital ; Epidemiology ; Friends ; Hand ; Humans ; Interpersonal Relations ; Mortality ; Retrospective Studies ; Spouses ; Violence

Objective: This study aimed to determine whether there is a difference in mortality and medical resource utilization between geriatric (aged ≥65 years) and super-geriatric patients (aged ≥80 years) with traumatic brain injury (TBI). Methods: We obtained comprehensive data (demographics, injury characteristics, injury severities, and outcomes) of geriatric and super-geriatric TBI patients from an emergency department-based injury surveillance system database from 2011 to 2016. Multivariate logistic regression analysis was performed to compare the mortality and nonroutine discharge (NRDC) status between both groups. Results: Among 442,533 TBI patients, 48,624 were older than 65 years. A total of 48,446 patients (37,140 geriatric and 11,306 super-geriatric) without exclusion criteria were included in the final analysis. Both overall in-hospital mortality (adjusted odds ratio, 1.88; 95% confidence interval [CI], 1.28 to 2.74; P=0.001) and NRDC (adjusted odds ratio, 1.35; 95% CI, 1.07 to 1.71; P=0.011) were significantly higher in the super-geriatric group. In the stratified analysis, there were no significant differences in NRDC rate for all stratifications of treatment timing (emergency department vs. ward admission), but mortality remained to be significant for all stratifications. Conclusion Super-geriatric TBI patients showed a significantly higher risk-adjusted overall mortality and more inadequate medical resource utilization than did geriatric TBI patients. However, super-geriatric patients were more likely to undergo NRDC after admission; thus, further research about age-related health inequalities is needed in the treatment of super-geriatric patients.

Objective: This study aimed to determine whether there is a difference in mortality and medical resource utilization between geriatric (aged ≥65 years) and super-geriatric patients (aged ≥80 years) with traumatic brain injury (TBI). Methods: We obtained comprehensive data (demographics, injury characteristics, injury severities, and outcomes) of geriatric and super-geriatric TBI patients from an emergency department-based injury surveillance system database from 2011 to 2016. Multivariate logistic regression analysis was performed to compare the mortality and nonroutine discharge (NRDC) status between both groups. Results: Among 442,533 TBI patients, 48,624 were older than 65 years. A total of 48,446 patients (37,140 geriatric and 11,306 super-geriatric) without exclusion criteria were included in the final analysis. Both overall in-hospital mortality (adjusted odds ratio, 1.88; 95% confidence interval [CI], 1.28 to 2.74; P=0.001) and NRDC (adjusted odds ratio, 1.35; 95% CI, 1.07 to 1.71; P=0.011) were significantly higher in the super-geriatric group. In the stratified analysis, there were no significant differences in NRDC rate for all stratifications of treatment timing (emergency department vs. ward admission), but mortality remained to be significant for all stratifications. Conclusion Super-geriatric TBI patients showed a significantly higher risk-adjusted overall mortality and more inadequate medical resource utilization than did geriatric TBI patients. However, super-geriatric patients were more likely to undergo NRDC after admission; thus, further research about age-related health inequalities is needed in the treatment of super-geriatric patients.

Arachnoid web is a very rare disease that occurs when the normal flow of cerebrospinal fluid is disturbed due to abnormal formation of the arachnoid membrane in the arachnoid space. Consequently, symptoms appear in the form of various myelopathies, such as loss of strength and sensation in the upper and lower extremities, or bladder control disorders. In general, surgical treatment can be considered if symptoms are exhibited. Arachnoid web requires a high consideration of appropriate diagnosis and treatment methods. However, due to its extremely rare occurrence in actual clinical practice, it is difficult to differentiate from other diseases such as herniated intervertebral disc or subdural tumor causing spinal myelopathy. This would effectively lead to a completely different direction of treatment. To date, there have been no case reports of Arachnoid web in Korea, except for collecting and reporting the focal anterior displacement of the thoracic spine, which is a similar lesion in the spinal cord. This article therefore provides information through case reports and literature review.

Arachnoid web is a very rare disease that occurs when the normal flow of cerebrospinal fluid is disturbed due to abnormal formation of the arachnoid membrane in the arachnoid space. Consequently, symptoms appear in the form of various myelopathies, such as loss of strength and sensation in the upper and lower extremities, or bladder control disorders. In general, surgical treatment can be considered if symptoms are exhibited. Arachnoid web requires a high consideration of appropriate diagnosis and treatment methods. However, due to its extremely rare occurrence in actual clinical practice, it is difficult to differentiate from other diseases such as herniated intervertebral disc or subdural tumor causing spinal myelopathy. This would effectively lead to a completely different direction of treatment. To date, there have been no case reports of Arachnoid web in Korea, except for collecting and reporting the focal anterior displacement of the thoracic spine, which is a similar lesion in the spinal cord. This article therefore provides information through case reports and literature review.