Orientia tsutsugamushi, a causative pathogen of Scrub typhus, is a gram-negative intracellular bacterium. Outer membrane vesicles (OMVs) are produced from the membrane of bacteria and play many roles related to the survival of the pathogen. However, there have been no reports confirming whether O. tsutsugamushi indeed produce OMVs. O. tsutsugamushi boryong was cultured in ECV-304 cells for the purification of OMVs. Western blot analysis and immunoenrichment using anti-O. tsutsugamushi monoclonal antibody and electron microscopy were employed for identification and characterization of OMVs. We confirm the presence of OMVs derived from O. tsutsugamushi, and also found that those OMVs contain a major surface antigen of 56-kDa protein and variant immunogenic antigens.
Antibodies, Monoclonal/*immunology ; Antigens, Bacterial/*immunology ; Antigens, Surface/*immunology ; Cell Line ; Cell Membrane/immunology ; Humans ; Microscopy, Electron ; Orientia tsutsugamushi/*immunology/metabolism ; Scrub Typhus/diagnosis/microbiology ; Secretory Vesicles/*immunology

OBJECTIVE: This study aimed to investigate the difference in micronutrient levels between oral feeding and enteral feeding in chronic stroke patients to assess the risks of enteral feeding. METHODS: Patients with chronic stroke who were admitted to the Department of Rehabilitation Medicine between January 2011 and June 2012 were enrolled. The serum concentrations of iron, copper, zinc, folate, and vitamin B12, as well as the absolute CD4 and CD8 lymphocyte counts, were assessed. RESULTS: Of the 73 patients enrolled in this study, 50 were fed orally, while the other 23 were fed through a percutaneous endoscopic gastrostomy (PEG) or nasogastric (NG) tube. The serum concentrations of vitamin B12 and folate were significantly higher in the enteral feeding group than in the oral feeding group. However, the serum concentration of zinc was significantly lower in the enteral feeding group. CONCLUSION: There is little difference between enteral feeding and oral feeding in terms of micronutrient provision except that the serum concentration of zinc in the enteral feeding group was significantly lower than that in the oral feeding group. Clinicians should recognize that chronic stroke patients who require tube feeding have a risk of micronutrient deficiency. Early detection of malnutrition and micronutrient deficiency is important for providing the necessary nutrients.
Copper ; Enteral Nutrition* ; Folic Acid ; Gastrostomy ; Humans ; Iron ; Lymphocyte Count ; Malnutrition ; Micronutrients* ; Rehabilitation ; Stroke* ; Vitamin B 12 ; Zinc

Arginase inhibition exhibits beneficial effects in vascular endothelial and smooth muscle cells. In human aortic smooth muscle cells (hAoSMCs), native low-density lipoprotein (nLDL) induced the production of interleukin-8 (IL-8) that is involved in the pathogenesis of cardiovascular diseases. Therefore, we examined the effect of arginase inhibition on IL-8 production and the underlying mechanism. In hAoSMCs, reverse transcription–PCR, western blotting and immunocytochemistry with MitoTracker confirmed that arginase II was confined predominantly to mitochondria. The mitochondrial membrane potential (MMP) was assessed using tetramethylrhodamine ethyl ester. The MMP decreased upon nLDL stimulation but was restored upon arginase inhibition. MMP loss caused by nLDL was prevented by treatment with the intracellular Ca(2+) chelator BAPTA-AM. In mitochondrial Ca(2+) measurements using Rhod-2 AM, increased mitochondrial Ca(2+) levels by nLDL were inhibited upon preincubation with an arginase inhibitor. Among the polyamines, spermine, an arginase activity-dependent product, caused mitochondrial Ca(2+) movement. The nLDL-induced MMP change resulted in p38 mitogen-activated protein kinase (MAPK) phosphorylation and IL-8 production and was prevented by the arginase inhibitors BAPTA and ruthenium 360. In isolated AoSMCs from ApoE(−/−) mice fed a high-cholesterol diet, arginase activity, p38 MAPK phosphorylation, spermine and mitochondrial Ca(2+) levels and keratinocyte-derived chemokine (KC) production were increased compared with wild-type (WT) mice. However, in AoSMCs isolated from arginase II-null mice, increases in MMP and decreases in mitochondrial Ca(2+) levels were noted compared with WT and were associated with p38 MAPK activation and IL-8 production. These data suggest that arginase activity regulates the change in MMP through Ca(2+) uptake that is essential for p38 MAPK phosphorylation and IL-8 production.

We present a patient with scrub typhus complicated with a splenic infarction. A 40-year-old man visited the emergency medical center complaining of fever for the previous week. He had no past medical history, but reported engaging in outdoor activities. Examination revealed a maculopapular rash on his trunk and an eschar on his epigastrium. Abdominal computed tomography was performed to examine the cause of the tenderness on the left upper quadrant of his abdomen, which revealed a splenic infarct. The patient was diagnosed with scrub typhus based on the results of blood polymerase chain reaction testing, and genetic sequencing confirmed the presence of Orientia tsutsugamushi Boryong. His symptoms improved following doxycycline treatment.
Abdomen ; Adult ; Chungcheongnam-do ; Doxycycline ; Emergencies ; Exanthema ; Fever ; Humans ; Orientia tsutsugamushi ; Polymerase Chain Reaction ; Scrub Typhus* ; Splenic Infarction*

We present a patient with scrub typhus complicated with a splenic infarction. A 40-year-old man visited the emergency medical center complaining of fever for the previous week. He had no past medical history, but reported engaging in outdoor activities. Examination revealed a maculopapular rash on his trunk and an eschar on his epigastrium. Abdominal computed tomography was performed to examine the cause of the tenderness on the left upper quadrant of his abdomen, which revealed a splenic infarct. The patient was diagnosed with scrub typhus based on the results of blood polymerase chain reaction testing, and genetic sequencing confirmed the presence of Orientia tsutsugamushi Boryong. His symptoms improved following doxycycline treatment.
Abdomen ; Adult ; Chungcheongnam-do ; Doxycycline ; Emergencies ; Exanthema ; Fever ; Humans ; Orientia tsutsugamushi ; Polymerase Chain Reaction ; Scrub Typhus* ; Splenic Infarction*

A 38-year-old male-to-female transgender patient who had undergone a transsexual operation 20 years earlier presented with right flank pain and chills. Abdominal CT scan and gastrografin colon enema revealed a right psoas abscess and an abnormal communication between the large bowel and this psoas abscess. She underwent a right hemicolectomy and was finally diagnosed as having a Klebsiella psoas abscess due to perforated diverticulitis and intestinal tuberculosis. Additional antibiotics and antituberculous medication were required. A secondary psoas abscess due to diverticulitis is rare, and to our knowledge, no case combined with intestinal tuberculosis has previously been reported. We present the case with a brief review of related reports.
Adult ; Anti-Bacterial Agents ; Chills ; Colon ; Diatrizoate Meglumine ; Diverticulitis ; Enema ; Flank Pain ; Humans ; Klebsiella ; Psoas Abscess ; Tuberculosis

A 38-year-old male-to-female transgender patient who had undergone a transsexual operation 20 years earlier presented with right flank pain and chills. Abdominal CT scan and gastrografin colon enema revealed a right psoas abscess and an abnormal communication between the large bowel and this psoas abscess. She underwent a right hemicolectomy and was finally diagnosed as having a Klebsiella psoas abscess due to perforated diverticulitis and intestinal tuberculosis. Additional antibiotics and antituberculous medication were required. A secondary psoas abscess due to diverticulitis is rare, and to our knowledge, no case combined with intestinal tuberculosis has previously been reported. We present the case with a brief review of related reports.
Adult ; Anti-Bacterial Agents ; Chills ; Colon ; Diatrizoate Meglumine ; Diverticulitis ; Enema ; Flank Pain ; Humans ; Klebsiella ; Psoas Abscess ; Tuberculosis

OBJECTIVE: To assess prosthetic use by upper extremity amputees, and their difficulties with prostheses in activities of daily living and occupations. METHOD: This study is based on a survey of 307 subjects, who were using prostheses manufactured in the Center of Prosthetics and Orthotics. The survey questionnaire included items about general demographic characteristics, side and level of amputation, type of prosthesis and its use, and difficulties in the activities of daily living, employment and driving. RESULTS: The most common type of prosthesis was the cosmetic hand type (80.2%). There were no statistically significant correlations between satisfaction with prosthesis and the amputation level or type of prosthesis. The most common difficulties in daily living activities experienced by amputees were lacing shoes, removing bottle-tops with a bottle opener, and using scissors. Only 7.3% of amputees received rehabilitation services. Less than half of the amputees (44.7%) used their prostheses for eight or more hours a day, and 76.9% used their prostheses for regular or irregular cosmetic purposes. After amputation, most of the respondents (69.0%) became unemployed or changed workplaces. CONCLUSION: In our study, respondents preferred cosmetic usage to functional usage. Only 30.0% of respondents reported satisfaction with their prostheses. Many of the amputees had difficulties in complex tasks and either changed jobs or became unemployed. Clerical workers were the occupation group, which was most likely to return to work. The development of a more functional prosthetic hand and additional rehabilitation services are required.
Activities of Daily Living ; Amputation ; Amputees ; Cosmetics ; Surveys and Questionnaires ; Employment ; Hand ; Humans ; Occupations ; Prostheses and Implants ; Return to Work ; Shoes ; Upper Extremity ; Surveys and Questionnaires

PURPOSE: Inadequate empirical therapy for severe infections caused by extended-spectrum beta-lactamase-producing Escherichia coli (ESBLEC) is associated with poor outcomes. This study was designed to investigate risk factors for community-onset ESBLEC bacteremia at admission to a tertiary care hospital. MATERIALS AND METHODS: A case-control study was performed that included all episodes of ESBLEC bacteremia in the outpatient department or within 48 hours of admission from January 2005 to March 2009. Data on predisposing factors were collected. The molecular epidemiology of ESBLEC clinical isolates was also determined. RESULTS: Among 25281 blood cultures, 60 episodes of ESBLEC bacteremia were studied, which accounted for 7% of all E. coli bacteremia at admission. Healthcare-associated infection [odds ratio (OR), 8.3; 95% confidence interval (CI), 2.4-28.7; p=0.001], malignancy (OR, 4.6; 95% CI, 1.3-16.3; p=0.018), urinary tract infection (OR, 139.1; 95% CI, 24.6-788.2; p<0.001), hepatobiliary infection (OR, 79.1; 95% CI, 13.5-463.8; p<0.001), third generation cephalosporin usage during preceding 3 months (OR, 16.4; 95% CI, 2.0-131.8; p=0.008), and severe sepsis/septic shock (OR, 73.7; 95% CI, 12.4-438.5; p<0.001) were determined as independent risk factors for community-onset ESBLEC bacteremia. The most common extended-spectrum beta-lactamase (ESBL) gene identified was bla(CTX-M-15) (n=31) followed by bla(CTX-M-14) (n=23). CONCLUSION: The most common types of ESBLs in E. coli causing community-onset bacteremia were CTX-M-15 and CTX-M-14 in Korea. By result of decision tree analysis, the empirical use of carbapenems is suggested only for patients with severe sepsis/septic shock, hepatobiliary infection, or healthcare-associated urinary tract infection.
Bacteremia* ; beta-Lactamases ; Carbapenems ; Case-Control Studies ; Causality ; Confidence Intervals ; Decision Trees ; Escherichia coli* ; Escherichia* ; Humans ; Korea ; Methods ; Molecular Epidemiology* ; Outpatients ; Risk Factors* ; Shock ; Tertiary Healthcare ; Urinary Tract Infections

Hemangioma in the gastrointestinal tract rarely occurs especially in the stomach compared with the small and large intestine. A 45-year-old man was admitted with pneumonia. After hematemesis, the authors performed gastroscopy, which revealed active bleeding on the huge ulcer on the antrum of the stomach and multiple erosive lesions on the whole stomach. After multiple submucosal hypertonic saline injection and hemoclipping at the huge ulcerative lesion, ulcer bleeding stopped. Three days later, recurrent massive upper gastrointestinal bleeding occured at the same site of the stomach. To prevent futher recurrent bleeding, total gastrectomy with esophagojejunostomy and splenectomy was done. The histologic diagnosis of the ulcerative lesion was hemangioma of mixed type. We report this rare case with the brief literature review.
Diagnosis ; Gastrectomy ; Gastrointestinal Hemorrhage* ; Gastrointestinal Tract ; Gastroscopy ; Hemangioma* ; Hematemesis ; Hemorrhage ; Humans ; Intestine, Large ; Middle Aged ; Pneumonia ; Splenectomy ; Stomach* ; Ulcer