No abstract available.
Prune Belly Syndrome*

No abstract available.
Prune Belly Syndrome*

PURPOSE: Surface antigen 3 (SAG3) of Toxoplasma gondii is very similar in structure to the major surface antigen 1 (SAG1). Although numerous studies have supported the importance of SAG1 in protection against T. gondii infection, few reports exist on SAG3. MATERIALS AND METHODS: Glutathione-S-transferase (GST)-fused SAG3 of T. gondii (rSAG3) were immunized into BALB/c mice alone or in combination with Quil A (rSAG3/Quil A), and then evaluated the protective immunity in vivo and in vitro against murine toxoplasmosis. RESULTS: Immunization with rSAG3 or rSAG3/Quil A resulted in significantly more survival days and fewer brain cysts after challenge with T. gondii compared to an infected control group. Mice immunized with rSAG3 alone or in combination with Quil A produced significantly more specific IgG2a antibody, whereas specific IgG1 antibody titers did not increase. The percentage of CD8+ T cells, IFN-gamma mRNA expression, and nitric oxide production significantly increased in rSAG3- and rSAG3/Quil A-immunized mice. CONCLUSION: These results indicate that vaccination with Toxoplasma rSAG3 results in partial protective immunity against T. gondii infection through induction of a Th1-type immune response, and that protective immunity is accelerated by the modulating effects of Quil A.
Animals ; Antigens, Protozoan/genetics/*immunology/metabolism ; Bacterial Proteins/genetics/immunology/metabolism ; Blotting, Western ; Enzyme-Linked Immunosorbent Assay ; Female ; Flow Cytometry ; Immunoglobulin G/immunology ; Interferon-gamma/metabolism ; Mice ; Mice, Inbred BALB C ; Nitric Oxide/metabolism ; Protozoan Proteins/genetics/immunology/metabolism ; Recombinant Fusion Proteins/genetics/immunology/metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Saponins/*immunology ; Toxoplasma/growth & development/*immunology ; Toxoplasmosis, Animal/*immunology/metabolism/microbiology ; Vaccination/*methods

PURPOSE: Surface antigen 3 (SAG3) of Toxoplasma gondii is very similar in structure to the major surface antigen 1 (SAG1). Although numerous studies have supported the importance of SAG1 in protection against T. gondii infection, few reports exist on SAG3. MATERIALS AND METHODS: Glutathione-S-transferase (GST)-fused SAG3 of T. gondii (rSAG3) were immunized into BALB/c mice alone or in combination with Quil A (rSAG3/Quil A), and then evaluated the protective immunity in vivo and in vitro against murine toxoplasmosis. RESULTS: Immunization with rSAG3 or rSAG3/Quil A resulted in significantly more survival days and fewer brain cysts after challenge with T. gondii compared to an infected control group. Mice immunized with rSAG3 alone or in combination with Quil A produced significantly more specific IgG2a antibody, whereas specific IgG1 antibody titers did not increase. The percentage of CD8+ T cells, IFN-gamma mRNA expression, and nitric oxide production significantly increased in rSAG3- and rSAG3/Quil A-immunized mice. CONCLUSION: These results indicate that vaccination with Toxoplasma rSAG3 results in partial protective immunity against T. gondii infection through induction of a Th1-type immune response, and that protective immunity is accelerated by the modulating effects of Quil A.
Animals ; Antigens, Protozoan/genetics/*immunology/metabolism ; Bacterial Proteins/genetics/immunology/metabolism ; Blotting, Western ; Enzyme-Linked Immunosorbent Assay ; Female ; Flow Cytometry ; Immunoglobulin G/immunology ; Interferon-gamma/metabolism ; Mice ; Mice, Inbred BALB C ; Nitric Oxide/metabolism ; Protozoan Proteins/genetics/immunology/metabolism ; Recombinant Fusion Proteins/genetics/immunology/metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Saponins/*immunology ; Toxoplasma/growth & development/*immunology ; Toxoplasmosis, Animal/*immunology/metabolism/microbiology ; Vaccination/*methods

BACKGROUND: Many terminally ill patients die while receiving life-sustaining treatment. Recently, the discussion of life-sustaining treatment in intensive care units (ICUs) has increased. This study is aimed to evaluate the current status of medical decision-making for dying patients. METHODS: The medical records of patients who had died in the medical ICU from March 2011 to February 2012 were reviewed retrospectively. RESULTS: Eighty-nine patients were enrolled. Their mean age was 65.8 +/- 13.3 years and 73.0% were male. The most common diagnosis was acute respiratory failure, and the most common comorbidity was hemato-oncologic malignancy. Withdrawing or withholding life-sustaining treatment including do-not-resuscitate (DNR) orders was discussed for 64 (71.9%) patients. In almost all cases, the discussion involved a physician and the patient's family. No patient wrote advance directives themselves before ICU admission. Of the patients for whom withdrawing or withholding life-sustaining treatment was discussed, the decisions were recorded in formal consent documents in 36 (56.3%) cases, while 28 (43.7%) cases involved verbal consent. In patients granting verbal consent, death within one day of the consent was more common than in those with formal document consent (85.7% vs. 61.1%, p < 0.05). The most common demand was a DNR order. Patients died 2.7 +/- 1.0 days after the decision for removal of life-sustaining treatment. CONCLUSIONS: The decision-making for life-sustaining treatment of dying patients in the ICU very often involves conflict. There is a general need to heighten our sensitivity on the objective decision-making based on patient autonomy.
Advance Directives ; Comorbidity ; Consent Forms ; Diagnosis ; Financing, Organized ; Humans ; Intensive Care Units* ; Male ; Medical Records ; Respiratory Insufficiency ; Retrospective Studies ; Terminal Care ; Terminally Ill

Sclerosinng mesenteritis is a rare disease that occurs most often among middle aged man. Fewer than 200 cases have been reported in the literature. It is a benign mesenteric lesion characterized by fat necrosis, fibrosis and chronic inflammation. The pathogenesis of this disease is unclear through an autoimmune origin has been proposed. The disease is generally localized and self- limiting. Fatal case is rare but has been reported. In patients with biopsy proven sclerosing mesenteritis having a relentless downhill course, treatment with prednisolone and oral cyclophosphamide in isolated case report has lead to evident clinical and radiological responses. This is a report of a case of sclerosing mesenteritis, who presented to us with history of colicky abdominal pain and weight loss. She was treated with prednisone and intravenous cyclophosphamide pulse therapy and resulted in radiological and clinical improvement. Interestingly this case has associated with skin panniculitis and pleural thickening. The skin panniculitis also showed good response to prednisolone. Our case is the first in which sclerosing mesenteritis was associated with pleural thickening.
Abdominal Pain ; Biopsy ; Cyclophosphamide ; Fat Necrosis ; Fibrosis ; Humans ; Inflammation ; Middle Aged ; Panniculitis* ; Panniculitis, Peritoneal* ; Prednisolone ; Prednisone ; Rare Diseases ; Skin* ; Weight Loss

PURPOSE: Shortage of donor organs is one of the major barriers to transplantation worldwide, especially, in countries where cadaveric organ donation is still limited. To overcome the donor kidney shortage, living unrelated donor renal transplantation should be one of the options to solve this problem. However, the data on the long-term results after unrelated donor renal transplantation and potential risk factors affecting the graft survival are scarce worldwide. We designed this retrospective study to report the long-term results of 967 renal transplants from unrelated donors in a single center. METHODS: From 1979 to June 2002, 2115 kidney transplantations were performed at Yonsei University Medical Center. Among them, a total of 1945 living donor transplants, excluding 55 cadaveric transplants and early 115 transplant who received azathioprine plus prednisone, were identified as a study cohort. The minimum and mean follow- up periods were 12 and 87.8 months, respectively. Of these, 978 transplants received living related donors (LRDs), and 967 patients underwent kidney transplantation using living unrelated donors (LURDs). For the analysis of risk factors affecting the graft survival, a couple of each demographic, immunologic, and clinical variates were included. RESULTS: The actuarial graft survival in the LRD and LURD recipients were 88.26% vs. 83.4% at 5 years, and 72.31% vs. 66.9% at 10 years, respectively. The 10-year patient survival rate for LRD and LURD transplants were 82.6% and 84%, respectively with no significant difference. On the multivariate analysis of LURD recipients, history of acute rejection, recipient age over 55 years, preoperative history of diabetes and hepatitis B viral infection were identified as a significant risk factor affecting the graft survival in LURD renal recipients. CONCLUSION: Excellent long-term patient and graft survivals were achieved among LURD kidney transplant recipients. Long-term outcome of transplants were not differed by the kinds of kidney donors. Renal transplantations using LURDs should be considered as an alternative way to increase the number of available donors.
Academic Medical Centers ; Azathioprine ; Cadaver ; Cohort Studies ; Graft Survival* ; Hepatitis B ; Humans ; Kidney Transplantation* ; Kidney* ; Living Donors ; Multivariate Analysis ; Prednisone ; Retrospective Studies ; Risk Factors* ; Survival Rate ; Tissue and Organ Procurement ; Tissue Donors ; Transplantation ; Transplants* ; Unrelated Donors*

Purpose: Neutrophils contribute to thrombosis. However, there is limited information on the temporal course of neutrophil recruitment in thrombosis, the contribution of neutrophils to thrombus growth, and the characteristics of stroke patients with neutrophil-rich thrombi. Materials and Methods: After inducing carotid artery thrombosis in Institute of Cancer Research mice using ferric chloride, aged thrombi were produced by ligating the distal portion of the carotid artery in mice for 0.5, 1, 2, 3, 6, or 24 h. For thrombus analysis in stroke patients, we used registry data and thrombi that were obtained during intra-arterial thrombectomy. Immunohistochemistry was performed to determine thrombus composition. Results: In the thrombi of 70 mice, Ly6G positive cell counts (neutrophils) and histone H3-positive cell counts increased in a time-dependent manner (both p<0.001). Ly6G-positive cell count was strongly correlated with histone H3-positive cell counts (r=0.910, p<0.001), but not with thrombus size (p=0.320). In 75 stroke patients, atrial fibrillation and cardioembolism were more frequent in the higher neutrophil group (32/37, 86.5%) than in the lower neutrophil group (19/38, 50%) (p=0.002). The median erythrocyte fraction was higher [52.0 (interquartile range 39.9−57.8)] in the higher neutrophil group than in the lower neutrophil group [40.3 (interquartile range 23.5−53.2)]. The fraction of neutrophils was positively correlated with that of erythrocytes (R=0.35, p=0.002). Conclusion Neutrophils were recruited and increased in arterial thrombosis in a time-dependent manner; however, they were not associated with the growth of formed thrombi. Neutrophil fractions in the thrombi of stroke patients appeared to be associated with atrial fibrillation and erythrocyte fraction.

Purpose: Neutrophils contribute to thrombosis. However, there is limited information on the temporal course of neutrophil recruitment in thrombosis, the contribution of neutrophils to thrombus growth, and the characteristics of stroke patients with neutrophil-rich thrombi. Materials and Methods: After inducing carotid artery thrombosis in Institute of Cancer Research mice using ferric chloride, aged thrombi were produced by ligating the distal portion of the carotid artery in mice for 0.5, 1, 2, 3, 6, or 24 h. For thrombus analysis in stroke patients, we used registry data and thrombi that were obtained during intra-arterial thrombectomy. Immunohistochemistry was performed to determine thrombus composition. Results: In the thrombi of 70 mice, Ly6G positive cell counts (neutrophils) and histone H3-positive cell counts increased in a time-dependent manner (both p<0.001). Ly6G-positive cell count was strongly correlated with histone H3-positive cell counts (r=0.910, p<0.001), but not with thrombus size (p=0.320). In 75 stroke patients, atrial fibrillation and cardioembolism were more frequent in the higher neutrophil group (32/37, 86.5%) than in the lower neutrophil group (19/38, 50%) (p=0.002). The median erythrocyte fraction was higher [52.0 (interquartile range 39.9−57.8)] in the higher neutrophil group than in the lower neutrophil group [40.3 (interquartile range 23.5−53.2)]. The fraction of neutrophils was positively correlated with that of erythrocytes (R=0.35, p=0.002). Conclusion Neutrophils were recruited and increased in arterial thrombosis in a time-dependent manner; however, they were not associated with the growth of formed thrombi. Neutrophil fractions in the thrombi of stroke patients appeared to be associated with atrial fibrillation and erythrocyte fraction.

Background: Although neuromyelitis optica spectrum disorder (NMOSD) is known to be a rare disease, its prevalence and incidence have not yet been studied in Korea. We performed a population-based study to examine the prevalence and incidence of NMOSD in Korea using data from the Korean National Health Insurance (NHI) claims database. Methods: Data from 2013 to 2017 were obtained, with a washout period set as 2013 and 2014. The prevalence and incidence of NMOSD in 2016 and 2017 were calculated using population census data. Subjects were divided into 5 groups at 15-year intervals, depending on the age at which the diagnostic code was entered. The relative risk (RR) for each age group was compared with the oldest (≥ 60 years) age group. Results: The overall prevalence was estimated to be 3.36 and 3.56 per 100,000 individuals, with an incidence of 0.41 and 0.65 per 100,000 individuals-year in 2016 and 2017, respectively. The mean age was 43.08 (standard deviation, 14.56) years, and the ratio of male to females was 1:4.7. The incidence was higher in female individuals aged between 30 and 59 years (RR, 2.8–3.05; P < 0.05). Conclusion Nationwide prevalence of NMOSD in Korea was 3.36 and 3.56/100,000 and its incidence was 0.41 and 0.65/100,000-year in 2016 and 2017 respectively.