PURPOSE: In patients with the congenitally corrected transposition of great arteries (CCTGA), systemic ventricle tends to be hypertrophic due to longstanding systemic high pressure that may lead to dysfunction of ventricle. The aim of this study was to assess the global and segmental wall function of systemic right ventricle in CCTGA. METHODS: Twelve patients with the CCTGA patients were enrolled. Ejection fraction of systemic right ventricle, myocardial performance index (MPI), strain and strain rate were assessed. RESULTS: The median age was 32.5 years with a range of 4 to 66 years. Ejection fraction (EF) using M-mode and Simpsons method was significantly lower in the CCTGA patients (48.5+/-4.6% and 51.2+/-4.1%, respectively, vs 63.7+/-3.6% and 66.6+/-3.8% respectively). 5 patients had diastolic dysfunction (3/12; pseudo-normalization pattern, 2/12; relaxation abnormality). Strain and strain rate revealed segmental systemic right ventricle dysfunction, and were lower in the CCTGA patients at mid and apical segment of septum and apical segment of anterior wall. The extent of dysfunctional segment was related to the age and MPI. CONCLUSION: There was global dysfunction in the CCTGA patients and it was related with age. Segmental dysfunction was especially shown at mid and apical segment of septum and apical segment of anterior wall and more frequently at apical segment of each wall. The extent of dysfunctional segment was related with age.
Arteries* ; Heart Ventricles ; Humans ; Relaxation ; Transposition of Great Vessels ; Ventricular Function, Right*

BACKGROUND: Viridans group streptococci (VGS) are both commensal microbes and potential pathogens. Increasing resistance to penicillin in VGS is an ongoing issue in the clinical environment. We investigated the difference in susceptibility and resistance to penicillin among various VGS species. METHODS: In total 1,448 VGS isolated from various clinical specimens were analyzed over a two-yr period. Identification and antimicrobial susceptibility test was performed by the automated VITEK 2 system (bioMerieux, France) or the MicroScan MICroSTREP system (Siemens, Germany). RESULTS: Among the 1,448 isolates, 412 were isolated from blood (28.4%). Streptococcus mitis group was the most frequently isolated (589 isolates, 40.7%), followed by the S. anginosus group (290 isolates, 20.0%), S. sanguinis group (179 isolates, 12.4%) and S. salivarius group (57 isolates, 3.9%). In total, 314 isolates could not be identified up to the species level. The overall non-susceptibility to penicillin was observed to be 40.0% (resistant, 11.2% and intermediately resistant, 28.8%) with uneven distribution among groups; 40.2% in S. sanguinis group (resistant, 5.0% and intermediately resistant, 35.2%), 60.3% in S. mitis group (resistant, 20.9% and intermediately resistant, 39.4%), 78.9% in S. salivarius group (resistant, 8.8% and intermediately resistant, 70.1%), and 6.2% in S. anginosus group (resistant, 1.7% and intermediately resistant, 4.5%). CONCLUSIONS: Antimicrobial resistance patterns towards penicillin show differences among various VGS; this should be considered while devising an effective antimicrobial treatment against VGS.
Anti-Infective Agents/*pharmacology ; Body Fluids/microbiology ; Drug Resistance, Bacterial ; Humans ; Microbial Sensitivity Tests ; Penicillins/pharmacology ; Streptococcal Infections/microbiology/pathology ; Viridans Streptococci/*drug effects/isolation & purification

BACKGROUND: Clostridial bacteremia (CB) is the second most frequent anaerobic bacteremia, and CB patients show high mortality without prompt antimicrobial therapy. We retrospectively reviewed 11 years of CB cases in a tertiary care hospital to describe the clinical and microbiological characteristics of CB and to define the risk factors of fatal CB. METHODS: All patients with CB from January 2002 to December 2012 were included in the study. Age, sex, underlying diseases, antibiotic use, and clinical outcome were reviewed. Antibiotic therapy was classified as either 'appropriate' or 'inappropriate' based on the activity against Clostridium species. RESULTS: A total of 118 Clostridium isolates (0.79% of all blood culture isolates) were recovered from the blood cultures of 114 patients. The underlying conditions of patients with CB were neoplasm in 87 cases (76.3%), gastrointestinal symptoms in 84 cases (73.7%), diabetes in 17 cases (14.9%), and hemodialysis in six cases (5.3%). Of the 118 Clostridium isolates, C. perfringens was the most frequent species (42 isolates, 35.6%). Thirty-two patients (28.1%) showed polymicrobial bacteremia, which was most commonly combined with Escherichia coli. Two patients harbored more than two Clostridium species. 'Appropriate' antibiotics were given to 97 (85.1%) patients. The mortality rate of CB at days 2, 8, and 30 was 7.9% (9/114), 14.0% (16/114), and 26.3% (30/114), respectively. CONCLUSION: Neoplasm, especially in the gastrointestinal tract or of hematologic origin, and hemodialysis were considered to be risk factors of blood stream clostridial infection. Early appropriate antibiotic coverage of CB was not definitely associated with lower mortality in our study.
Anti-Bacterial Agents ; Bacteremia* ; Bacteria, Anaerobic ; Clostridium ; Escherichia coli ; Gastrointestinal Tract ; Humans ; Korea* ; Mortality ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; Rivers ; Sepsis ; Tertiary Healthcare*

The prevalence of nonalcoholic fatty liver disease (NAFLD) has increased with the incidence of obesity; however, the underlying mechanisms are unknown. In this study, high-resolution metabolomics (HRM) along with transcriptomics were applied on animal models to draw a mechanistic insight of NAFLD. Wild type (WT) and catalase knockout (CKO) mice were fed with normal fat diet (NFD) or high fat diet (HFD) to identify the changes in metabolic and transcriptomic profiles caused by catalase gene deletion in correspondence with HFD. Integrated omics analysis revealed that cholic acid and 3β, 7α-dihydroxy-5-cholestenoate along with cyp7b1 gene involved in primary bile acid biosynthesis were strongly affected by HFD. The analysis also showed that CKO significantly changed all-trans-5,6-epoxy-retinoic acid or all-trans-4-hydroxy-retinoic acid and all-trans-4-oxo-retinoic acid along with cyp3a41b gene in retinol metabolism, and α/γ-linolenic acid, eicosapentaenoic acid and thromboxane A2 along with ptgs1 and tbxas1 genes in linolenic acid metabolism. Our results suggest that dysregulated primary bile acid biosynthesis may contribute to liver steatohepatitis, while up-regulated retinol metabolism and linolenic acid metabolism may have contributed to oxidative stress and inflammatory phenomena in our NAFLD model created using CKO mice fed with HFD.

The molecular mechanism underlying the initiation of somatic cell reprogramming into induced pluripotent stem cells (iPSCs) has not been well described. Thus, we generated single-cell-derived clones by using a combination of drug-inducible vectors encoding transcription factors (Oct4, Sox2, Klf4 and Myc) and a single-cell expansion strategy. This system achieved a high reprogramming efficiency after metabolic and epigenetic remodeling. Functional analyses of the cloned cells revealed that extracellular signal-regulated kinase (ERK) signaling was downregulated at an early stage of reprogramming and that its inhibition was a driving force for iPSC formation. Among the reprogramming factors, Myc predominantly induced ERK suppression. ERK inhibition upregulated the conversion of somatic cells into iPSCs through concomitant suppression of serum response factor (SRF). Conversely, SRF activation suppressed the reprogramming induced by ERK inhibition and negatively regulated embryonic pluripotency by inducing differentiation via upregulation of immediate early genes, such as c-Jun, c-Fos and EGR1. These data reveal that suppression of the ERK-SRF axis is an initial molecular event that facilitates iPSC formation and may be a useful surrogate marker for cellular reprogramming.

PURPOSE: This study was performed to find the chief clinical problems associated with the ages of adult patients of tetralogy of Fallot(TOF) who had undergone total correction. METHODS: Of the 30 patients who were registered at the Grown-Up Congenital Heart Disease (GUCH) Clinic of Samsung Medical Center for TOF, a retrospective investigation was carried out on 28 patients who underwent total correction. RESULTS: Mean age at retrospective study was 30.8(range : 16-53) years old. Age at total correction was 15.8(range : 2-49) years old. Problems after corrective surgery were assessed. They were arrhythmia, pulmonary valve regurgitation, left pulmonary artery stenosis, residual ventricular septal defect, mitral valve regurgitation, tricuspid valve regurgitation, right ventricle outflow tract obstruction, aortic valve regurgitation, infective endocarditis and protein losing enteropathy. After repair of TOF, such arrhythmias as atrial arrhythmia and AV conduction disturbances were observed in some patients. Cardiomegaly was found significantly in the subjects with arrhythmia(P<0.05), and arrhythmia was less observed in patients who underwent surgery at a young age. Eight patients required a reoperation; the main indications were residual ventricular septal defect, right ventricle outflow tract obstruction and peripheral pulmonary artery stenosis. CONCLUSION: The majority of the patients seemed to live normal lives after Tetralogy of Fallot repair. However, as residual anatomic and functional abnormalities exist postoperatively, continued careful follow-up is needed to detect and correct structural and functional abnormalities.
Adult* ; Aortic Valve ; Arrhythmias, Cardiac ; Cardiomegaly ; Constriction, Pathologic ; Endocarditis ; Follow-Up Studies* ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Mitral Valve Insufficiency ; Protein-Losing Enteropathies ; Pulmonary Artery ; Pulmonary Valve Insufficiency ; Reoperation ; Retrospective Studies ; Tetralogy of Fallot* ; Tricuspid Valve Insufficiency