The necessary role of genital infection by specific types of human papillomavirus (HPV) in cervical cancer development provides an opportunity to reduce the risk of cervical cancer, a second leading cancer in women, through prophylactic vaccination. Two types of vaccines targeting HPV 16 and 18 which are responsible for about 70% of all cervical cancer worldwide have been developed: a quadrivalent vaccine (Gardasil?) and a bivalent vaccine (Cervarix?). Gardasil also targets HPV 6 and 11 causing 90% of genital wart. Both two vaccines contain virus-like particles composed of L1 protein of viral capsid and do not exert infectivity. HPV vaccines were highly effective in preventing persistent infection by vaccine specific type HPV in young women who have not been previously exposed to them. Randomized double-blind placebo-controlled clinical trials have provided evidence that HPV vaccines have high efficacy against cervical precancerous lesion in young women irrespective of baseline HPV infection status. However, HPV vaccines neither treat existing HPV infections nor provide protection against all types of HPV related with cervical cancer. Therefore, even vaccinated females should take cervical cancer screening as recommended. Gardasil has been tested mainly in 9~26 years old females and Cervarix in 15~25 years old. Current recommendation for vaccination age is 9~26 years for Gardasil and 10~25 years for Cervarix, considering sexual debut and previous clinical trials. There are plenty of remaining issues regarding HPV vaccination such as vaccine efficacy in older women and in males, cost-effectiveness, duration of protection, cross-protection, potential replacement infection, and vaccine compatibility.
Cancer Vaccines ; Capsid ; Condylomata Acuminata ; Female ; Human papillomavirus 16 ; Human papillomavirus 18 ; Human papillomavirus 6 ; Humans ; Male ; Mass Screening ; Papillomavirus Vaccines ; Uterine Cervical Neoplasms ; Vaccination ; Vaccines ; Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18

Emphysematous pyelonephritis is an unusual, severe gas-forming infection of renal parenchyma and its surrounding areas. It is a rare cause of septic pulmonary embolism. We report on a case of emphysematous pyelonephritis complicated with renal vein thrombosis and septic pulmonary embolism with review of the literature. A 51-year-old diabetic woman was admitted to our hospital with symptoms of fever, diffuse abdominal pain and nausea. Her initial laboratory findings showed pyuria and leukocytosis. She was diagnosed with acute pyelonephritis with abscess formation on contrast enhanced abdominal CT. She was treated with antibiotics and percutaneous abscess aspiration, but progressed to emphysematous pyelonephritis complicated with renal vein thrombosis and septic pulmonary embolism. Finally she underwent the left total nephrectomy.
Abdominal Pain ; Abscess ; Anti-Bacterial Agents ; Female ; Fever ; Humans ; Leukocytosis ; Middle Aged ; Nausea ; Nephrectomy ; Pulmonary Embolism ; Pyelonephritis ; Pyuria ; Renal Veins ; Sepsis ; Thrombosis

Background and Objectives: To analyze mapping changes in dynamic range (DR) and neural response threshold (NRT) as prognostic factors for cochlear implant (CI). To analyze whether postoperative speech perception performance could be predicted using DR change and initial NRT. Subjects and Methods: The speech comprehension data of 33 patients with CI were retrospectively analyzed after 1, 3, 6, and 12 months of device use. All subjects were adult, postlingually hearing-impaired, and Cochlear Nucleus CI users. Speech perception performance was evaluated using aided pure tone audiometry, consonant, vowel, one-word, two-word, and sentence tests. Results: The averages of initial NRT and DR changes were 197.8±25.9 CU (104–236) and 22.2±18.4 CU (-15–79), respectively. The initial DR was 40.8±16.6 CU. The postoperative DR was 50.3±16.4 CU at 3 months, 58±12.3 CU at 6 months, and 62.9±10.4 CU at 12 months. A gradual increase of DR was observed during the first year of CI. Compared with the initial DR, significant increases in DR were observed at 3 (p<0.05), 6 (p<0.001), and 12 (p<0.001) months. Compared with initial speech performance outcomes, a significant gain in all performance outcomes was achieved at 12 months (p<0.001). Conclusions Patients with low NRT after CI surgery could initially set DR to a wider range and had better final speech perception outcomes. Conversely, patients with high NRT after CI surgery had to set up a gradual increase in DR while adjusting the T-C level, and the final speech perception outcomes were worse. DR and NRT, the main CI mapping variables, can help predict prognosis related to speech perception outcomes after CI surgery. In conclusion, the post-CI speech perception is better with a lower initial NRT, wider final DR, or younger age.

Background and Objectives: Hearing loss (HL) and its repercussions are major problems in today’s society. There are limited data on the relationship between degree of HL and otologic disorders. The aim of this study is to estimate mortality rates, rates of sudden idiopathic HL and related otologic surgical procedures in hearing disability patients in South Korea. Subjects and Methods: Retrospective medical data for 160,205 patients with hearing disability was extracted. Mortality rates, rates of sudden idiopathic HL and related otologic surgical procedures were compared with a normal control group consisting of 865,475 people; approximately 5 times the number of hearing disability patients. Results: According to the Korean National Disability Registry (NDR), 0.458% of the population in South Korea suffered from hearing disability in 2015. Higher rates of mortality and sudden idiopathic HL were reported in hearing disability patients, increasing up to a maximum of 1.594 times and 1,039.695 times, respectively, compared to the normal control group. Mastoidectomy surgery was 2.5 times more frequently performed and pressure equalizing (PE) tube insertion was about 15 times more frequently performed in hearing disability patients. Conclusions Hearing disability is related to higher risks of mortality, sudden idiopathic HL and otologic surgical procedures, including mastoidectomy and PE tubing.

Mycobacterium avium complex (MAC) is the most common pathogen in nontuberculous mycobacterial lung diseases, but vertebral osteomyelitis caused by MAC is rare. We experienced a case of vertebral osteomyelitis with epidural abscess in a rheumatoid arthritis patient who received immunosuppressive agents. Initial assessment was tuberculous vertebral osteomyelitis, and then treated with antituberculous drugs. Fifty-six days later, Mycobacterium intracellulare was identified from abscess culture and drugs were altered to clarithromycin, rifabutin, and ethambutol. After 3 months of M. intracellulare treatment, the radiological findings showed increases of epidural abscess. According to the suseptibility, the patient received intravenous amikacin for four weeks, and then, oral ciprofloxacin in addition to clarithromycin, rifabutin, and ethambutol. The patient is being treated with the medication for 13 months and currently showing slow improvements.
Abscess ; Amikacin ; Arthritis, Rheumatoid ; Ciprofloxacin ; Clarithromycin ; Epidural Abscess ; Ethambutol ; Humans ; Immunosuppressive Agents ; Lung Diseases ; Mycobacterium ; Mycobacterium avium Complex ; Nontuberculous Mycobacteria ; Osteomyelitis ; Rifabutin

Dendritic cells (DCs) play a key role in activating the immune response against invading pathogens as well as dying cells or tumors. Although the immune response can be initiated by the phagocytic activity by DCs, the molecular mechanism involved in this process has not been fully investigated. Trp-Lys-Tyr-Met-Val-Met-NH2 (WKYMVM) stimulates the activation of phospholipase D (PLD) via Ca2+ increase and protein kinase C activation in mouse DC cell line, DC2.4. WKYMVM stimulates the phagocytic activity, which is inhibited in the presence of N-butanol but not t-butanol in DC2.4 cells. Furthermore, the addition of phosphatidic acid, an enzymatic product of PLD activity, enhanced the phagocytic activity in DC2.4 cells. Since at least two of formyl peptide receptor (FPR) family (FPR1 and FPR2) are expressed in DC2.4 as well as in mouse bone marrow-derived dendritic cells, this study suggests that the activation of FPR family by WKYMVM stimulates the PLD activity resulting in phagocytic activity in DC2.4 cells.
1-Butanol/pharmacology ; Animals ; Bone Marrow Cells/cytology/metabolism ; Calcium Signaling/*drug effects ; Cell Death/immunology ; Cell Line ; Communicable Diseases/immunology ; Dendritic Cells/immunology/*metabolism ; Mice ; Neoplasms/immunology ; Oligopeptides/*pharmacology ; Phagocytosis/*drug effects ; Phosphatidic Acids/pharmacology ; Phospholipase D/*metabolism ; Receptors, Formyl Peptide/*metabolism ; Research Support, Non-U.S. Gov't ; tert-Butyl Alcohol/pharmacology

Inflammatory bowel diseases (IBD) is heterogeneous, chronic relapsing disorder. Inappropriate and exaggerated immune response for the luminal antigen is known as a main pathogenesis. Genetic, infectious, and environmental factors are responsible for unbalanced immune response, but the definite pathogenesis is still unclear. Genetic factor is the most important role of all. That is based on high concordance rate of identical twins and family history. The incident rate and prevalence of IBD for the Asian population is relatively lower than Western population, and the lack of NOD2 or TLR4 genetic polymorphisms in Korea and Japanese population suggests the difference in genetic background between Asian and Western population. In Korea, the case of familial aggregation of IBD is pretty rare. We report a case of the daughter with ulcerative colitis and her mother with Crohn's disease who have a -159C/T promoter polymorphism of CD14 gene for IBD.
Antigens, CD14/genetics ; Colitis, Ulcerative/*diagnosis/drug therapy/genetics ; Colonoscopy ; Crohn Disease/*diagnosis/genetics ; Female ; Genetic Predisposition to Disease ; Humans ; Mesalamine/therapeutic use ; Middle Aged ; Mothers ; Polymorphism, Restriction Fragment Length ; Tomography, X-Ray ; Young Adult

Inflammatory bowel diseases (IBD) is heterogeneous, chronic relapsing disorder. Inappropriate and exaggerated immune response for the luminal antigen is known as a main pathogenesis. Genetic, infectious, and environmental factors are responsible for unbalanced immune response, but the definite pathogenesis is still unclear. Genetic factor is the most important role of all. That is based on high concordance rate of identical twins and family history. The incident rate and prevalence of IBD for the Asian population is relatively lower than Western population, and the lack of NOD2 or TLR4 genetic polymorphisms in Korea and Japanese population suggests the difference in genetic background between Asian and Western population. In Korea, the case of familial aggregation of IBD is pretty rare. We report a case of the daughter with ulcerative colitis and her mother with Crohn's disease who have a -159C/T promoter polymorphism of CD14 gene for IBD.
Antigens, CD14/genetics ; Colitis, Ulcerative/*diagnosis/drug therapy/genetics ; Colonoscopy ; Crohn Disease/*diagnosis/genetics ; Female ; Genetic Predisposition to Disease ; Humans ; Mesalamine/therapeutic use ; Middle Aged ; Mothers ; Polymorphism, Restriction Fragment Length ; Tomography, X-Ray ; Young Adult

Inflammatory myofibroblastic tumors (IMTs) are solid neoplastic mesenchymal proliferations composed of myofibroblastic spindle cells admixed with inflammatory infiltrates. The documented sites in the gastrointestinal tract include the esophagus, small intestine, colon, appendix, rectum, pancreas, spleen, liver, and Meckel's diverticulum. Biliary IMTs are rare, and IMTs arising from the ampulla of Vater have not been reported previously. Herein we report the case of a 65-year-old woman with an extrahepatic biliary obstruction due to IMT of the ampulla of Vater, and a successful therapeutic approach using endoscopic ultrasonography and endoscopic papillectomy.
Aged ; Ampulla of Vater ; Appendix ; Colon ; Endosonography ; Esophagus ; Female ; Gastrointestinal Tract ; Humans ; Intestine, Small ; Liver ; Meckel Diverticulum ; Myofibroblasts ; Pancreas ; Rectum ; Spleen

BACKGROUND: Acute adaptive vascular remodeling occurs in active and unstable inflammatory plaques. It has been suggested that the adaptive coronary vascular remodeling, in patients with acute coronary syndrome (ACS), may be systemic and may show similar vascular remodeling in the carotid arteries. We investigated the ultrasonographic features of the common carotid artery (CCA) to determine whether the arterial expansive remodeling found in the coronary artery occurs in the carotid arteries of patients with ACS. METHODS: We measured lumen diameter (LD), interadventitial diameter (IAD) and intima media thickness (IMT) using a B-mode ultrasound in both common carotid arteries in patients with ACS (N=74) and chronic stable angina (CSA) (N=31). Positive remodeling was arbitrarily defined as an IMTmax >1 mm and IAD >8 mm and negative remodeling as an IMTmax >1 mm and IAD <7 mm. Other values were defined as "no remodeling" RESULTS: There were no significant differences in LD IAD and maximal IMT of the right CCA and the left CCA in comparisons between the ACS and the CSA patient groups. There were no differences for number of cases with no remodeling or differences in positive and negative remodeling in the right common carotid artery and left common carotid artery in comparisons between the ACS and CSA patient groups. . Presence of plaque in both common carotid arteries showed similar frequency in the ACS and CSA patient groups. The characteristics of carotid artery plaques were not different in the two groups. The remodeling index (IAD/LD) was correlated with IMTmax (right CCA r=0.797, p<0.001; left CCA r=0.860, p<0.001). CONCLUSIONS: The common carotid arterial structure of ACS patients was not different from that of CSA patients. Therefore, these results suggest that the expansive arterial remodeling, due to coronary inflammatory plaques, appears to take place locally rather than systemically.
Acute Coronary Syndrome* ; Angina, Stable* ; Carotid Arteries* ; Carotid Artery, Common ; Carotid Stenosis ; Coronary Vessels ; Humans ; Ultrasonography