Colonization of the pre-transplant lung by multidrug-resistant bacteria affects short- and long-term outcomes of lung transplantation. However, there are no case reports on the colonization of a pre-transplant lung by drug-resistant Acinetobacter baumannii. We report a case of extensively drug resistant (XDR) A. baumannii colonization in the tracheobronchial tree that caused severe infectious complications after bilateral lung transplantation. A 23-year-old man diagnosed with bronchiolitis obliterans syndrome (BOS) 4 years earlier with a history of allogenic bone marrow transplantation for acute lymphoblastic leukemia was admitted to the hospital with dyspnea. Due to progressive hypercapnic respiratory failure, long-term mechanical ventilation was started after a tracheostomy was performed, and the patient underwent a bilateral lung transplantation to treat end-stage BOS. After the transplantation, the colonization of XDR A. baumannii caused severe bacterial pneumonia in the early postoperative period. Combined treatment with colistin and meropenem led to recovery from the pneumonia but caused drug-induced renal failure. Because many centers are willing to transplant candidates who are on mechanical ventilation or extracorporeal life support, the incidence of XDR A. baumannii colonization of pretransplant lungs is expected to increase. Further studies are needed to examine pre-transplant management strategies in patients colonized with XDR A. baumannii.
Acinetobacter baumannii* ; Bacteria ; Bone Marrow Transplantation ; Bronchiolitis Obliterans ; Colistin ; Colon* ; Drug Resistance ; Dyspnea ; Humans ; Incidence ; Lung ; Lung Transplantation* ; Pneumonia ; Pneumonia, Bacterial ; Postoperative Period ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Renal Insufficiency ; Respiration, Artificial ; Respiratory Insufficiency ; Tracheostomy ; Young Adult

OBJECTIVES: The aim of this research was to determine the pH-dependent changes in F-ATPase activity and proton fluxes in Streptococcus mutans (S. mutans) as induced by varying the concentration of fluoride ±10 mM (0.058% (v/v)) ethanol. METHODS: S. mutans UA159 was grown in Brain Heart Infusion medium at pH 4.8, 6.8, or 8.8. The F-ATPase assay was initiated by the addition of ATP, and stopped by adding 10% trichloroacetic acid. For the proton flux assay, bacterial suspensions were titrated to pH 4.6 with 0.5 M HCl, and then 0.5 M HCl was added to decrease the pH values in units of approximately 0.4 pH. The subsequent increase in pH was monitored using a glass electrode. To disrupt the cell membrane, 10% (v/v) butanol was added to the suspensions after 80 minutes. RESULTS: At all pH levels, fluoride ±10 mM ethanol not only decreased F-ATPase activity but also increased the proton permeability of S. mutans. The largest effects were observed at pH 4.8. Ethanol enhanced these effects only at pH 4.8. CONCLUSIONS: A very low concentration of ethanol enhanced the action of fluoride on F-ATPase activity and the proton permeability in S. mutans at acidic pH levels. We expect that low concentrations of ethanol may be used together with fluoride and/or other anticaries agents to develop more effective anticaries preparations.
Adenosine Triphosphate ; Brain ; Cell Membrane ; Electrodes ; Ethanol* ; Fluorides* ; Glass ; Heart ; Hydrogen-Ion Concentration ; Permeability* ; Protons* ; Streptococcus mutans* ; Streptococcus* ; Suspensions ; Trichloroacetic Acid

Lymphangioma of the esophagus is a rare submucosal benign tumor. A 49-year-old man was referred because of a foreign body sensation in the esophagus. In endoscopy, a 10.0×1.0-cm longitudinal, translucent, whitish yellow mass covered with normal esophageal mucosa was found in the lower esophagus. Endoscopic ultrasonography revealed a heterogeneous, mainly hypoechoic, well-circumscribed lesion located in the third layer. Incisional biopsy was performed, and histologic findings showed multiple dilated lymphatic vessels, consistent with lymphangioma. After 3 months of proton pump inhibitor treatment, the symptom was relieved and the patient is currently asymptomatic and under surveillance.
Biopsy ; Endoscopy ; Endosonography ; Esophagus ; Foreign Bodies ; Humans ; Lymphangioma ; Lymphatic Vessels ; Middle Aged ; Mucous Membrane ; Proton Pumps ; Sensation

Objectives: ：The aim of the present study is to investigate the impact of COVID-19 on the incidence and severity of childhood and adolescent self-harm. Methods: ：Medical records were retrospectively reviewed for patients under the age of 18 who visited the emergency room of Konyang University Hospital to compare the rate of self-harm attempts and the demographic, clinical, and self-harm-related of self-harm attempters aspects before and after the COVID-19 outbreak. Results: ：During 11 months after the COVID-19 outbreak, the proportion of the number of children and adolescents patients with self-harm and their episodes increased significantly compared to that during 11 months be-fore the COVID-19 outbreak (χ2 =14.397, p<0.001; χ2 =24.156, p<0.001). Between about the year before and after the outbreak of COVID-19, there was a significant difference in the prior self-harm history and psychiatric history among children and adolescents who visited the emergency room and the ratio of hospitalization to other departments than department of psychiatry (p<0.05; p<0.05; p<0.05). Conclusions ：In the COVID-19 situation, the proportion of children and adolescents who visited the emergency room due to self-harm and admission to other departments are increasing. And it has been shown that the inci-dence of self-harm has significantly increased in children and adolescents with a history of prior self-harm and psychiatric past history. These findings underscore the need for the psychiatric evaluation and intervention of self-harm related high-risk groups among children and adolescents in pandemic situations.

OBJECTIVES: As a first step to study the anticaries effect of ethanol alone, we investigated the effects of ethanol on the expression levels of the atpB gene and proton permeability of Streptococcus mutans in suspension cultures. METHODS: S. mutans UA159 was grown in brain heart infusion medium at either pH 4.8 or 6.8. The total extracted RNA was reverse-transcribed into cDNA using a Superscript™ First-Strand Synthesis System. The resulting cDNA and negative controls were amplified by ABI PRISM 7700 real-time PCR system with SYBR Green PCR Master Mix. For proton flux assay, bacterial suspensions were titrated to pH 4.6 with 0.5 M HCl, and then additional 0.5 M HCl was added to decrease the pH values by approximately 0.4 units. The subsequent increase in pH was monitored using a glass electrode. Ten percent (v/v) butanol was added to the suspensions at 80 min to disrupt the cell membrane. RESULTS: In a concentration-dependent manner, ethanol alone not only decreased the growth rate of S. mutans and the expression of the atpB gene but also increased the proton permeability at both pH 4.8 and 6.8. CONCLUSIONS: These findings suggest that ethanol has the potential for an anticaries ingredient. We believe that ethanol may be used together with fluoride and/or other cariostatic agents in order to develop better anticaries toothpastes and/or mouthrinses.
Brain ; Cariostatic Agents ; Cell Membrane ; DNA, Complementary ; Electrodes ; Ethanol ; Fluorides ; Gene Expression ; Glass ; Heart ; Hydrogen-Ion Concentration ; Permeability ; Polymerase Chain Reaction ; Protons ; Real-Time Polymerase Chain Reaction ; RNA ; Streptococcus mutans ; Streptococcus ; Suspensions ; Toothpastes

Colonization of the pre-transplant lung by multidrug-resistant bacteria affects short- and long-term outcomes of lung transplantation. However, there are no case reports on the colonization of a pre-transplant lung by drug-resistant Acinetobacter baumannii. We report a case of extensively drug resistant (XDR) A. baumannii colonization in the tracheobronchial tree that caused severe infectious complications after bilateral lung transplantation. A 23-year-old man diagnosed with bronchiolitis obliterans syndrome (BOS) 4 years earlier with a history of allogenic bone marrow transplantation for acute lymphoblastic leukemia was admitted to the hospital with dyspnea. Due to progressive hypercapnic respiratory failure, long-term mechanical ventilation was started after a tracheostomy was performed, and the patient underwent a bilateral lung transplantation to treat end-stage BOS. After the transplantation, the colonization of XDR A. baumannii caused severe bacterial pneumonia in the early postoperative period. Combined treatment with colistin and meropenem led to recovery from the pneumonia but caused drug-induced renal failure. Because many centers are willing to transplant candidates who are on mechanical ventilation or extracorporeal life support, the incidence of XDR A. baumannii colonization of pretransplant lungs is expected to increase. Further studies are needed to examine pre-transplant management strategies in patients colonized with XDR A. baumannii.
Acinetobacter baumannii ; Bacteria ; Bone Marrow Transplantation ; Bronchiolitis Obliterans ; Colistin ; Colon ; Drug Resistance ; Dyspnea ; Humans ; Incidence ; Lung ; Lung Transplantation ; Pneumonia ; Pneumonia, Bacterial ; Postoperative Period ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Renal Insufficiency ; Respiration, Artificial ; Respiratory Insufficiency ; Tracheostomy ; Young Adult

Emphysematous pyelonephritis (EPN) is a severe gas-forming infection of the renal parenchyma and surrounding tissues. Patients with EPN commonly present with high fever, chills, and flank pain. These symptoms mimic a simple urinary tract infection, such that diagnosis is often delayed. Because of its life-threatening fulminant course, the early detection of EPN and its prompt treatment with intravenous antibiotics with or without percutaneous drainage are critical. Here we describe a case of a 63-year-old Korean female with diabetes mellitus who had no specific symptoms or signs of EPN. A chest computed tomography (CT) scan to assess a right pleural effusion incidentally detected an abnormal gas shadow in the renal parenchyma. An abdominal CT scan performed 5 days later showed increased gas within the kidney parenchyma, but the patient still had no symptoms of EPN. She was treated with intravenous antibiotics alone. A follow-up abdominal CT scan revealed the complete disappearance of the features of EPN.
Anti-Bacterial Agents ; Chills ; Diabetes Mellitus ; Diagnosis ; Drainage ; Female ; Fever ; Flank Pain ; Follow-Up Studies ; Humans ; Kidney ; Middle Aged ; Pleural Effusion ; Pyelonephritis* ; Thorax ; Tomography, X-Ray Computed ; Urinary Tract Infections

PURPOSE: We applied a simplified method using polymerase chain reaction (PCR)-based enzymatic digestion for the detection of epidermal growth factor receptor (EGFR) mutation. MATERIALS AND METHODS: We selected 74 samples of adenocarcinoma of the lung with EGFR exons 19 and 21 that had been previously sequenced. We designed PCR primers and chose a DNA restriction enzyme. Seventy four additional lung cancer samples were tested as a test set. For test sets, the PCR-based method was performed first, followed by validation of the result by DNA sequencing. RESULTS: In the first sample group, we found 15 (20.3%) mutations in exon 19, and 9 (12.2%) mutations in exon 21 using the sequencing method. By using the PCR-based method, we were able to identify all of the mutated samples detected by the sequencing method. The PCR-based method also detected mutations in exon 19 in three additional samples and in exon 21 in one additional sample. In the second sample group, by performing the PCR-based method, we found 10 (13.5%) and 7 (9.5%) mutations in exons 19 and 21, respectively. Additional mutations in exon 19 were identified in 2 samples by the sequencing method. However, the sequencing method failed to identify a mutation in exon 21 in one sample. CONCLUSION: The sensitivity of the PCR-based enzymatic digestion method seems to be comparable to that of the traditional sequencing method for detecting EGFR mutations. Our method can be widely used as a screening test to select patients who may benefit from EGFR targeted therapy.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Digestion ; DNA ; DNA Restriction Enzymes ; Epidermal Growth Factor ; Exons ; Genes, erbB-1 ; Humans ; Lung ; Lung Neoplasms ; Mass Screening ; Polymerase Chain Reaction ; Receptor, Epidermal Growth Factor ; Restriction Mapping

Henoch-Schönlein purpura (HSP) is a systemic vasculitis involving the small vessels with distinct clinical features. The etiology of HSP is diverse, and viral infection is one of the many predisposing factors. Cytomegalovirus (CMV) infection mostly affects immune-suppressed patients, but rarely patients with normal immunity can also be affected. Authors experienced a case of HSP patient, with underlying small-cell lung cancer (SCLC) with CMV duodenitis. This is a rare case of HSP diagnosed in SCLC patient with predisposing factor of CMV infection.
Causality ; Cytomegalovirus* ; Duodenitis* ; Humans ; Lung Neoplasms ; Purpura* ; Systemic Vasculitis

No abstract available.
Gastrectomy* ; Hyperhomocysteinemia ; Obesity, Morbid* ; Thrombophilia*