BACKGROUND: In order to reduce the diagnostic window period between the time of human immunodeficiency virus (HIV) infection and serological diagnosis, new fourth generation screening assays which detect HIV p24 antigen and specific antibody simultaneously have been developed. In this study, we evaluated the performance of a new fourth generation assay. METHODS: We compared a new fourth generation assay, Architect HIV Ag/Ab combo, with another fourth generation assay AxSYM HIV Ag/Ab combo and a third generation assay, AxSYM HIV 1/2 gO for their performance. The assays were evaluated using 3 HIV seroconversion panels, 305 sera of healthy subjects and 100 sera of patients with HBsAg or anti-HCV antibodies. Within-run and total coefficient variations of the three screening assays were analyzed for the evaluation of precision. RESULTS: Architect HIV Ag/Ab combo shortened the window period by 8.7+/-2.1 days relative to AxSYM HIV 1/2 gO and 2.0+/-2.0 days relative to AxSYM HIV Ag/Ab combo in seroconversion panels. Architect HIV Ag/Ab combo presented the best performance in precision among the three reagents; total CV for positive control was 3.6%, 9.6% and 4.6% for Architect HIV Ag/Ab combo, AxSYM HIV Ag/Ab combo and AxSYM HIV 1/2 gO, respectively. Specificities of three assays were not different in this study. CONCLUSIONS: HIV Ag/Ab combined assays reduced the diagnostic window as compared to the third generation screening assays, enabling an earlier diagnosis of HIV infection. A new fourth generation assay, Architect HIV Ag/Ab combo presents a better performance than AxSYM HIV Ag/Ab combo, showing improved seroconversion sensitivity and precision.
Diagnosis ; Hepatitis B Surface Antigens ; Hepatitis C Antibodies ; HIV Core Protein p24 ; HIV Infections ; HIV Seropositivity ; HIV* ; Humans ; Indicators and Reagents ; Mass Screening

BACKGROUND: Myocardial calcium overload during reperfusion may contribute to myocardial stunning. The protective effect of nicardipine against post-ischemic myocardial dysfunction was investigated. METHODS: Twenty-two halothane-anesthetized dogs were subjected to 15 minutes of left anterior descending coronary artery (LAD) occlusion and subsequent 3 hour reperfusion. One group of dogs (n=11) received nicardipine (1 microgram/kg/min) and another group (n=11) received saline (0.5 ml/kg/h) through intracoronary catheter for 1 hour beginning 15 minutes before LAD occlusion. Systolic shortening (%SS) and preload recruitable stroke work slope (Mw), as an index of regional myocardial contractility, and IMP-tau (time constant of myocardial relaxation based on intramyocardial pressure (IMP)) and post-systolic shortening (%PSS), as an index of regional diastolic function, were evaluated. LAD blood flow was measured by Doppler flowmeters as well. RESULTS: Regional systolic as well as diastolic functions during acute myocardial ischemia were similar between the two groups. However, Mw recovered to the baseline value with the onset of reperfusion in the nicardipine group but was significantly decreased throughout the reperfusion period in the controls. After 3 hours of reperfusion, the nicardipine group had recovered 67% of %SS, compared with 20% of the control group. IMP-tau was restored to the baseline value by 60 min of reperfusion in the control group but was significantly prolonged in the nicardipine group throughout the reperfusion period. CONCLUSIONS: Intracoronary nicardipine enhances the recovery of regional contractile function but prolongs myocardial relaxation in the canine model of myocardial stunning.
Animals ; Calcium ; Catheters ; Coronary Vessels ; Dogs* ; Flowmeters ; Myocardial Ischemia ; Myocardial Stunning* ; Nicardipine* ; Relaxation ; Reperfusion ; Stroke

Myopericarditis is an uncommon manifestation, but can be reaely a lethal complication of infectious mononucleosis. We experienced a case of infectious mononucleosis complicated by myopericarditis in which the clinical pictur was confused as acute myocarddial infarction. A 25-year-old male who presented with syncope and chest pain. The diagnosis of infectious mononucleosis was comfirmed by both a positive heterophil antibody test and a high titer of Epstein-Barr virus antibody. He was found to have completely normal findings at cardiac catheterization, including coronary arteriography. Pathologic specimen from right ventricular endomyocardial biopsy demonstrated extensive lymphocytic and eosinophilic infiltration of the myocardium.
Adult ; Angiography ; Biopsy ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Diagnosis ; Eosinophils ; Herpesvirus 4, Human ; Humans ; Infarction ; Infectious Mononucleosis* ; Male ; Myocardium ; Syncope

BACKGROUND AND OBJECTIVES: The effects of hyperglycemia on the mucin secretion in inflammatory respiratory diseases are not clear. Therefore, this study was conducted to characterize the effect of hyperglycemia, and the mechanism involved, on MUC5AC and MUC5B expression in human airway epithelial cells. SUBJECTS AND METHOD: The NCI-H292 cells and the primary cultures of human nasal epithelial cells were exposed to different concentration of glucose (5, 10, 15, 20, 30 mM) for 8 or 24 hours, the effects of high concentration of glucose (20 mM) on MUC5AC and MUC5B expression were determined using reverse transcriptase-polymerase chain reaction (PCR), real-time PCR and enzyme immunoassay. Measurement of reactive oxygen species (ROS) production was performed by flow cytometry. To investigate the role of ROS in high concentration of glucose-induced MUC5B expression, the cells were pretreated with N-acetyl-cysteine (NAC, 50 mM) as a ROS scavenger, or diphenyleneiodonium (DPI, 100 nM) as a nicotinamide adenine dinucleotide phosphate oxidase inhibitor for 1 hour. RESULTS: In the NCI-H292 cells and the primary cultures of human nasal epithelial cells, High concentration of glucose increased MUC5B expression but did not increase MUC5AC expression (p<0.05). ROS production was also increased by high concentration of glucose (20 mM) (p<0.05). In addition, high concentration of glucose (20 mM)-induced MUC5B expression and ROS production were significantly attenuated by pretreatment of NAC (50 mM) or DPI (100 nM) (p<0.05). CONCLUSION: High concentration of glucose induces MUC5B expressions via ROS in human airway epithelial cells.
Epithelial Cells* ; Flow Cytometry ; Glucose* ; Humans* ; Hyperglycemia ; Immunoenzyme Techniques ; Methods ; Mucins ; NADP ; Oxidoreductases ; Reactive Oxygen Species* ; Real-Time Polymerase Chain Reaction

Activities of Daily Living ; Animals ; Cats ; Humans ; Information Services ; Multivariate Analysis ; Outpatients ; Pulmonary Disease, Chronic Obstructive ; Sputum ; Thorax

BACKGROUND: The chronic obstructive pulmonary disease (COPD) assessment test (CAT) is a validated, eight-item questionnaire used to quantify the health status of patients. The aim of this study was to evaluate the usefulness of the CAT questionnaire as a tool to assess the response to treatment in acute exacerbations of COPD in an outpatient setting. METHODS: A multicenter, phase 3 randomized controlled trial was conducted previously to examine the efficacy and safety of oral zabofloxacin for the treatment of COPD exacerbations. In the present post hoc analysis of the original study, patients with COPD exacerbation were categorized as responders or non-responders according to the respiratory symptoms persisting on day 10 (visit 3) of treatment. The CAT questionnaire was completed daily by patients at home from the initial visit to the second visit on day 5. Subsequently, the questionnaire was completed in the presence of a physician on days 10 (visit 3) and 36 (visit 4). Multivariate regression analysis was performed to determine the association between CAT scores and the therapeutic response. RESULTS: The CAT scores decreased more rapidly in responders compared to non-responders during the first 5 days (23.3–20.4 vs. 23.5–22). Among responders, patients with higher severity of illness also revealed higher CAT scores on the first day of an exacerbation (mild, 19.8; moderate, 21.4; severe, 23.8; very severe, 28.6). Multivariate analysis revealed that a change in the CAT score during the first 3 days influenced the therapeutic response. A significant decrease in scores in the domains of sputum production, chest tightness, and activities of daily living was seen among responders. CONCLUSION Early improvement in CAT scores may be associated with a more favorable response to the treatment of COPD exacerbations.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01658020TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0000532

A 60-year-old woman with end stage liver cirrhosis caused by genotype 2 hepatitis C virus (HCV) infection received an orthotopic liver transplantation (OLT). The patient was negative for the hepatitis B surface antigen (HBsAg) and positive for the anti-hepatitis B surface antibody (anti-HBs) prior to and one and a half months following the OLT. Due to reactivation of hepatitis C, treatment with interferon-alpha and Ribavirin started two months following the OLT and resulted in a sustained virological response. We performed a liver biopsy because a biochemical response was not achieved. Surprisingly, liver pathology showed HBsAg-positive hepatocytes with a lobular hepatitis feature, which had been negative in the liver biopsy specimen obtained one and a half months post-OLT. High titers of both HBsAg and HBeAg were detected, while anti-HBs antibodies were not found. Tests for IgM anti-hepatitis B core antibody and anti-delta virus antibodies were negative. The serum HBV DNA titer was over 1x10(7) copies/mL. A sequencing analysis showed no mutation in the "a" determinant region, but revealed a mixture of wild and mutant strains at an overlapping region of the S and P genes (S codon 213 (Leu/Ile); P codons 221 (Phe/Tyr) and 222 (Ala/Thr)). These findings suggest that de novo hepatitis B can develop in patients with HCV infection during the post-OLT period despite the presence of protective anti-HBs.
Antibodies ; Biopsy ; Codon ; DNA ; Female ; Genotype ; Hepacivirus ; Hepatitis ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis C ; Hepatocytes ; Humans ; Immunoglobulin M ; Interferon-alpha ; Liver ; Liver Cirrhosis ; Liver Transplantation ; Middle Aged ; Ribavirin ; Superinfection ; Viruses

Dermatomyositis (DM) is a systemic inflammatory disease affecting skeletal muscles and other organs. Spontaneous pneumomediastinum (PnM) has been previously reported as a rare complication of DM and it is known to occur more frequently in patients with interstitial lung disease (ILD). Here we report on a case of a 52-year-old woman with DM who developed spontaneous PnM, which was treated successfully with high-dose steroid pulse therapy and cyclosporine A (CsA). This case suggests that CsA can be an effective therapeutic agent in DM refractory to glucocorticoid therapy, with ILD or pulmonary fibrosis accompanied by DM. CsA should be considered as an initial immunosuppressive agent for patients with PnM in DM.
Cyclosporine* ; Dermatomyositis* ; Female ; Humans ; Lung Diseases, Interstitial ; Mediastinal Emphysema* ; Middle Aged ; Muscle, Skeletal ; Pulmonary Fibrosis

The purpose of this study was to compare the Korean COPD guideline to GOLD consensus report in terms of acute exacerbation. A total of 361 patients were enrolled in this study, and 16.9% of them experienced acute exacerbation during the follow-up. A total of 6.3% of patients in GOLD A, 9.5% in GOLD B, 7.7% in GOLD C and 17.0% of GOLD D experienced exacerbation during the first year of follow-up, respectively (P=0.09). There was no one who experienced exacerbation during the first year of follow-up in the Korean group 'ga'. The 12-month exacerbation rates of Korean group 'na' and 'da' were 4.5% and 16.0%, respectively (P<0.001). We explore the experience of exacerbation in patients with change of their risk group after applying Korean COPD guideline. A total of 16.0% of the patients who were reclassified from GOLD A to Korean group 'da' experienced acute exacerbation,and 15.3% from GOLD B to Korean group 'da' experienced acute exacerbation. In summary, the Korean COPD guideline is useful to differentiate the high risk from low risk for exacerbation in terms of spirometry. This indicates that application of Korean COPD guideline is appropriate to treat Korean COPD patients.
Acute Disease ; Aged ; Disease Progression ; Female ; Humans ; Male ; *Practice Guidelines as Topic ; Pulmonary Disease, Chronic Obstructive/*classification/*diagnosis ; Pulmonary Medicine/*standards ; Reproducibility of Results ; Republic of Korea ; Sensitivity and Specificity ; *Severity of Illness Index ; Spirometry/*standards

PURPOSE: Comparisons of the characteristics of chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome (ACOS) have been the focus of several studies since the diseases were defined by the Global Initiative for Asthma and Global Initiative for Chronic Obstructive Lung Disease guidelines. However, no consensus is available yet. In this study, we aimed to compare the characteristics of asthma-COPD overlap (ACO) and COPD. METHODS: We retrospectively reviewed 1,504 patients with COPD in a Korean COPD Subtype Study cohort. The occurrence of ACO was defined as a positive response to a bronchodilator (an increase in forced expiratory volume in 1 second [FEV1] of 12% and 200 mL). RESULTS: Among 1,504 patients with COPD, 223 (14.8%) were diagnosed with ACO. Men (95.5%) and current smokers (32.9%) were more prevalent in the ACO group compared with the pure COPD group (90.5% and 25.3%, respectively; P=0.015 and P=0.026, respectively). Patients with ACO had a better quality of life (St. George's Respiratory Questionnaire for COPD score=31.0±18.0 [mean±standard deviation]) than those with pure COPD (35.3±19.1) (P=0.002). Although the prevalence of acute exacerbation was not different between the 2 groups, patients with severe exacerbation required hospital admission significantly more frequently in the pure COPD group than in the ACO group. Patients with ACO showed a higher likelihood of FEV1 recovery than those with pure COPD (P<0.001). CONCLUSIONS: We suggest that ACO is characterized by less severe symptoms, and therefore it might lead to rare severe exacerbation and the possibility of lung function recovery.
Asthma ; Cohort Studies* ; Consensus ; Disease Progression ; Forced Expiratory Volume ; Humans ; Lung ; Male ; Prevalence ; Pulmonary Disease, Chronic Obstructive* ; Quality of Life ; Recovery of Function ; Retrospective Studies