Background: Skin diseases characterized by epithelial barrierdysfunction show altered sphingolipid metabolism,which results in changes in the stratum corneum intercellularlipid components and structure. Under pathological conditions,1-deoxysphingolipids form as atypical sphingolipidsfrom de novo sphingolipid biosynthesis. Objective: Thisstudy investigated the potential role of 1-deoxysphingolipidsin skin barrier dysfunction secondary to X-ray and ultravioletB (UVB) irradiation in vitro and in vivo. It was also evaluatedchanges in the expression of 1-deoxysphingolipids in lesionalhuman skin of atopic dermatitis. Methods: In thisstudy, the changes in these 1-deoxysphingolipids levels ofskin and serum samples were investigated in skin barrier dysfunctionassociated with X-ray and UVB irradiation in vitroand in vivo. Results: Increased 1-deoxysphingolipids were observed in cultured normal human epidermal keratinocytesafter X-ray irradiation. X-ray or UVB irradiation increased theproduction of 1-deoxysphingosine in a reconstituted 3-dimensional(3D) skin model. Interestingly, treatment with aphysiological lipid mixture (multi-lamellar emulsion containedpseudoceramide), which can strengthen the epidermalpermeability barrier function, resulted in decreased1-deoxysphingosine formation in a reconstituted 3D skinmodel. Further investigation using a hairless mouse modelshowed similar preventive effects of physiological lipid mixtureagainst 1-deoxysphingosine formation after X-ray irradiation.An increased level of 1-dexoysphingosine in the stratumcorneum was also observed in lesional skin of atopic dermatitis. Conclusion 1-deoxysphingosine might be a novelbiomarker of skin barrier dysfunction and a physiological lipidmixture treatment could prevent 1-deoxysphingosine productionand consequent skin barrier dysfunction.

The detailed kinetics of the cytomegalovirus (CMV)-specific T cell response in hematopoietic stem cell transplant (HCT) recipients have not yet been fully assessed. We evaluated these kinetics of CMV-specific T cell response and factors associated with high CMV-specific T cell responses 1 year after HCT. In HCT recipients, CMV pp65 and IE1-specific ELISPOT assay were performed before HCT (D0), and at 30 (D30), 90 (D90), 180 (D180), and 360 (D360) days after HCT. Of the 51 HCT recipients with donor-positive (D+)/recipient-positive (R+) serology, 26 (51%) developed CMV infections after HCT. The patterns of post-transplantation reconstitution for CMV-specific T cell response were classified into 4 types: 1) an initial decrease at D30 followed by gradual T cell reconstitution without CMV infection (35%), 2) an initial decrease at D30 followed by gradual T cell reconstitution preceded by CMV infection (35%), 3) failure of gradual or constant T cell reconstitution (26%), and 4) no significant T cell reconstitution (4%). There was no significant difference between ELISPOT counts of D360 and those of D0. High CMV-specific T cell responses at D360 were not associated with high CMV-specific T cell response at D0, CMV infection, ganciclovir therapy, graft versus host disease (GVHD), and immunosuppressant use. In conclusion, there are 4 distinct patterns of reconstitution of the CMV-specific T cell response after HCT. In addition, reconstituted donor-origin CMV-specific T cell responses appeared to be constant until day 360 after HCT, regardless of the level of the pre-transplant CMV-specific T cell response, CMV infection, and immunosuppressant use.
Cytomegalovirus ; Enzyme-Linked Immunospot Assay ; Follow-Up Studies* ; Ganciclovir ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Kinetics* ; Theophylline

BACKGROUND AND OBJECTIVES: Trapped thrombus in patent foramen ovale (PFO) is a rare complication of pulmonary embolism that may lead to tragic clinical events. The aim of this study was to identify the optimal treatment for different clinical situations in patients with trapped thrombus in a PFO by conducting a literature review. SUBJECTS AND METHODS: A PubMed database search was conducted from 1991 through 2015, and 194 patients (185 articles) with trapped thrombus in a PFO were identified. Patient characteristics, paradoxical embolic events, and factors affecting 60-day mortality were analyzed retrospectively. RESULTS: Among all patients, 112 (57.7%) were treated with surgery, 28 with thrombolysis, and 54 with anticoagulation alone. Dyspnea (79.4%), chest pain (33.0%), and syncope (17.5%) were the most common presenting symptoms. Pretreatment embolism was found in 37.6% of cases, and stroke (24.7%) was the most common event. Surgery was associated with fewer post-treatment embolic events than were other treatment options (p=0.044). In the multivariate analysis, initial shock or arrest, and thrombolysis were independent predictors of 60-day mortality. Thrombolysis was related with higher 60-day mortality compared with surgery in patients who had no initial shock or arrest. CONCLUSION: This systematic review showed that surgery was associated with a lower overall incidence of post-treatment embolic events and a lower 60-day mortality in patients with trapped thrombus in a PFO. In patients without initial shock or arrest, thrombolysis was related with a higher 60-day mortality compared with surgery.
Chest Pain ; Dyspnea ; Embolism ; Foramen Ovale, Patent* ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Pulmonary Embolism ; Retrospective Studies ; Shock ; Stroke ; Syncope ; Thrombosis*

BACKGROUND/AIMS: Cytomegalovirus (CMV) surveillance and preemptive therapy is a widely-used strategy for preventing CMV disease in transplant recipients. However, there are limited data on the incidence and patterns of CMV disease during the preemptive period. Thus, we investigated the incidence and pattern of tissue-invasive CMV disease in CMV seropositive kidney transplantation (KT) and hematopoietic stem cell transplantation (HCT) recipients during preemptive therapy. METHODS: We prospectively identified patients with tissue-invasive CMV disease among 664 KT (90%) and 496 HCT (96%) recipients who were D+/R+ (both donor and recipient seropositive) during a 4-year period. RESULTS: The incidence rates of CMV disease were 4.1/100 person-years (4%, 27/664) in KT recipients and 5.0/100 person-years (4%, 21/496) in HCT recipients. Twenty-six (96%) of the KT recipients with CMV disease had gastrointestinal CMV, whereas 17 (81%) of the HCT recipients had gastrointestinal CMV and 4 (19%) had CMV retinitis. Thus, CMV retinitis was more common among HCT recipients (p = 0.03). All 27 KT recipients with CMV disease suffered abrupt onset of CMV disease before or during preemptive therapy; 10 (48%) of the 21 HCT recipients with CMV disease were also classified in this way but the other 11 (52%) were classified as CMV disease following successful ganciclovir preemptive therapy (p < 0.001). CONCLUSIONS: The incidence of CMV disease was about 4% in both KT and HCT recipients during preemptive therapy. However, CMV retinitis and CMV disease as a relapsed infection were more frequently found among HCT recipients.
Cytomegalovirus* ; Ganciclovir ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells* ; Humans ; Incidence ; Kidney Transplantation ; Kidney* ; Prospective Studies ; Retinitis ; Tissue Donors ; Transplant Recipients*

BACKGROUND: The non-invasive differentiation of ischemic and nonischemic acute heart failure (AHF) not resulting from acute myocardial infarction is difficult and has therapeutic and prognostic implications. The aim of this study was to assess whether resting myocardial contrast echocardiography (MCE) can detect coronary artery disease (CAD) in patients with decreased left ventricular (LV) systolic function and global hypokinesis presenting with AHF. METHODS: Twenty-one consecutive patients underwent low-power real-time MCE based on color-coded pulse inversion Doppler. Standard apical LV views were acquired during contrast IV infusion of Definity(R). Following transient microbubbles destruction, the contrast replenishment rate (beta), reflecting myocardial blood flow velocity, was derived by plotting signal intensity vs. time and fitting data to the exponential function: y (t) = A (1 - e(-beta(t-t0))) + C. RESULTS: Of the 21 (mean age 56.6 +/- 13.6 years) patients, 5 (23.8%) demonstrated flow-limiting CAD (> 70% of luminal diameter narrowing). The mean +/- standard deviation of LV ejection fraction was 29.6 +/- 8.6%. Quantitative MCE analysis was feasible in 258 of 378 segments (68.3%). There were no significant difference in "beta" and "Abeta" in patients without and with CAD (0.48 +/- 0.27 vs. 0.45 +/- 0.25, p = 0.453 for beta and 2.99 +/- 2.23 vs. 3.68 +/- 3.13, p = 0.059 for Abeta, respectively). No contrast-related side effects were reported. CONCLUSION: Resting quantitative MCE analysis in patients with AHF was feasible, however, the parameters did not aid in detecting of CAD.
Blood Flow Velocity ; Coronary Artery Disease* ; Coronary Disease ; Diagnosis ; Echocardiography* ; Heart Failure* ; Humans ; Microbubbles ; Myocardial Infarction ; Phenobarbital ; Pilot Projects*

We describe a 64-year-old male patient with panhypopituitarism who experienced polymorphic ventricular tachycardia (VT) associated with long QT intervals. The panhypopituitarism developed as a sequelae of radiation therapy administered 20 years prior to his current presentation and was recently aggravated by urinary tract infection with sepsis. In this case, polymorphic VT was resistant to conventional therapy (including magnesium infusion), and QT prolongation and T wave inversion were normalized after the administration of steroid and thyroid hormones. Thyroid hormone is generally known to be associated with torsades de pointes (TdP), but steroid or other hormones may also provoke TdP. Hormonal disorders should be considered as a cause of polymorphic VT with long QT intervals. Some arrhythmias can be life-threatening, and they can be prevented with supplementation of the insufficient hormone.
Arrhythmias, Cardiac ; Humans ; Hypopituitarism ; Long QT Syndrome ; Magnesium ; Male ; Sepsis ; Tachycardia, Ventricular ; Thyroid Gland ; Thyroid Hormones ; Torsades de Pointes ; Urinary Tract Infections

PURPOSE: To investigate the surgical outcomes of patients with femoral mid-diaphyseal fractures treated with minimally invasive plate osteosynthesis (MIPO), which were difficult to intramedullary nailing. MATERIALS AND METHODS: We evaluated 11 patients with femoral mid-diaphyseal fractures who were treated with MIPO. There were 7 males and 4 females and the mean age was 47 years (20-85 years). According to AO/OTA classification, there were 1 type of A1, 5 types of A3, 1 of B2 and 4 of B3. The reason of plate fixation instead of intramedullary nailing is as follows: femoral vessel and severe soft tissue injuries-2 cases, polytrauma patients with chest injury-6 cases, and narrow medullary canal diameter-3 cases. Six out of 11 cases were treated with initial external fixation as a damage control orthopedics. RESULTS: The mean union time of 6 cases was 3.7 months (3-5 months). There were 5 cases (45%) of nonunion, which should be treated with autogenous bone graft. All cases of nonunion resulted from severe soft tissue damage and polytrauma, which needed initial external fixation. There was no case of malalignment and implant-related complication. CONCLUSION: In cases of difficult intramedullary nailing for the femoral mid-diaphyseal fractures, MIPO could be an alternative surgical option, but concurrent soft tissue injuries and multiple trauma may increase the risk of nonunion in spite of biological fixation.
Female ; Femur ; Fracture Fixation, Intramedullary ; Glycosaminoglycans ; Humans ; Male ; Multiple Trauma ; Soft Tissue Injuries ; Thorax ; Transplants

Dilated cardiomyopathy (DCM) is usually an idiopathic disease with a poor prognosis. Hypocalcemia is a rare and reversible cause of DCM. Here, we report a 50-year-old female with DCM, induced by idiopathic hypoparathyroidism, that improved after treatment with calcium.
Calcium/administration & dosage ; Cardiomyopathy, Dilated/diagnosis/*etiology/physiopathology ; Dietary Supplements ; Electrocardiography ; Female ; Humans ; Hypocalcemia/diagnosis/drug therapy/*etiology ; Hypoparathyroidism/*complications/diagnosis/drug therapy ; Middle Aged ; Recovery of Function ; Treatment Outcome ; Vitamin D/administration & dosage

PURPOSE: The osseointegration around titanium mini-implants installed in macroporous biphasic calcium phosphate (MBCP) blocks was evaluated after incubation with recombinant human bone morphogenetic protein-2 (rhBMP-2) in an ectopic subcutaneous rat model. METHODS: Mini-implants (phi1.8x12 mm) were installed in MBCP blocks (bMBCPs, 4x5x15 mm) loaded with rhBMP-2 at 0.1 mg/mL, and then implanted for 8 weeks into subcutaneous pockets of male Sprague-Dawley rats (n=10). A histomorphometric analysis was performed, and the bone-to-implant contact (BIC) and bone density were evaluated. RESULTS: Significant osteoinductive activity was induced in the rhBMP-2/bMBCP group. The percentage of BIC was 41.23+/-4.13% (mean+/-standard deviation), while bone density was 33.47+/-5.73%. In contrast, no bone formation was observed in the bMBCP only group. CONCLUSIONS: This model represents a more standardized tool for analyzing osseointegration and bone healing along the implant surface and in bMBCPs that excludes various healing factors derived from selected animals and defect models.
Animals ; Bone Density ; Bone Morphogenetic Protein 2 ; Calcium ; Dental Implants ; Humans ; Hydroxyapatites ; Male ; Nitrogen Mustard Compounds ; Osseointegration ; Osteogenesis ; Rats ; Rats, Sprague-Dawley ; Recombinant Proteins ; Titanium ; Transforming Growth Factor beta

A total of 91 non-typhoid Salmonella isolated from pediatric patients with diarrhea in Seoul from 2003 to 2009 was tested for antimicrobial susceptibility of nalidixic acid (NA). Forty strains of NA resistance or intermediate susceptible non-typhoid Salmonella were identified and their minimum inhibitory concentrations (MICs) of NA, ciprofloxacin (CIP), and norfloxacin (NOR) were determined. Of the 40 isolates, 26 were resistant to NA (MIC >256 microg/ml). Only one isolate was high-level resistant to CIP (12 microg/ml) and NOR (48 microg/ml). Mutations in gyrA and parC genes were studied by PCR and sequencing. All NA-resistant isolates carried point mutations in the gyrA quinolone resistance determining regions (QRDR) at codon 83 or 87 (MICs of NA, >256 microg/ml; MICs of CIP, 0.047~0.25 microg/ml; MICs of NOR, 0.38~1.5 microg/ml). A double change in GyrA was found in one Salmonella Enteritidis (MIC of CIP, 12 microg/ml; MIC of NOR, 48 microg/ml). In respect of the ParC protein, a single change at Thr57-->Ser was found in 3 isolates (MICs of NA, >256 microg/ml; MICs of CIP, 0.19~0.25 microg/ml; MICs of NOR, 1 microg/ml). At the same time, these strains changed from Ser83 to Tyr in the gyrA. The result of the investigation for the prevalence of plasmid-mediated quinolone resistance (PMQR) genes, 14 isolates harbored qnr gene among 40 isolates. All of 14 isolates showed decreased susceptibility at NA (MICs 4~16 microg/ml) and except one strain, all of qnr genes were identified as qnrB. Mutations in the gyrA gene and production of PMQR determinants were critical for quinolone resistance and decreased susceptibility to fluoroquinolone in these isolates.
Ciprofloxacin ; Codon ; Diarrhea ; DNA Topoisomerase IV ; Humans ; Microbial Sensitivity Tests ; Nalidixic Acid ; Norfloxacin ; Point Mutation ; Polymerase Chain Reaction ; Prevalence ; Salmonella ; Salmonella enteritidis ; Sprains and Strains