PURPOSE: Appropriate antibiotic therapy is important in childhood urinary tract infection and the selection of anibiotics is based on antimicrobial sensitivity of Escherichia coli. Extended- Spectrum beta-Lactamase(ESBL) is an enzyme produced by gram-negative bacilli that has the ability to hydrolyse penicillins, broad-spectrum cephalosporin and monobactam. There have been many reports of outbreaks of hospital infection by ESBL-producing organism. However, community-acquired infection with ESBL-producing organism are rare. This study was performed to retrospectively identify the incidence, characteristics and risk factors of ESBL(+) E. coli in community-acquired childhood UTI. METHODS: In 288 children admitted in Ewha Womans University Hospital with E. coli UTI from Mar 2001 to February 2003, ESBL was isolated. ESBL was confirmed by the utilization of an automatized machine(Vitek GNS 433 card) using liquid medium dilution method according to National Committee for Clinical Laboratory Standard. The clinical characteristics, risk factors, antimicrobial resistance and treatment effectiveness were compared with ESBL(-) E. coli UTI. RESULTS: Of 288 E. coli isolates, 31(10.8%) produced ESBL and 93.5%(29/31) occurred in infants younger than 6 month of age(P<0.01). No significant differences were noted in prior antibiotic use, prior admission history and underlying urogenital anomaly. Antimicrobial resistance was significantly higher in ESBL(+) E. coli compared with control patients (P< 0.05). Although ceftriaxone showed 100% resistance in ESBL(+) E. coli, bacteriologic sterilization rate after ceftriaxone therapy was higher(96.8%). However, the recurrence rate of febrile UTI within 6 months was higher(25.8%) than control patients(6.6%). CONCLUSION: Epidemiologic study is required to find out any new risk factors of community-acquired ESBL(+) E. coli UTI and changes in selection of empirical antibiotics shouldbe considered
Anti-Bacterial Agents ; Ceftriaxone ; Child ; Community-Acquired Infections ; Cross Infection ; Disease Outbreaks ; Epidemiologic Studies ; Escherichia coli* ; Escherichia* ; Female ; Humans ; Incidence* ; Infant ; Penicillins ; Recurrence ; Retrospective Studies ; Risk Factors* ; Sterilization ; Treatment Outcome ; Urinary Tract Infections* ; Urinary Tract*

BACKGROUND AND OBJECTIVES: When a disability is superimposed on a previous disability, the concept of aggravation of disability should be applied. In rating the disability for hearing loss, we focused on the aggravation of disability and the methods of assessment. SUBJECTS AND METHOD: For the past 12 years, we have provided legal advisory for 111 cases of hearing injury, for which disability had to be rated. In 11 of those 111 cases, disability was assessed in consideration of aggravation of disability. We assessed disability using three rating methods: they were based on 1) a change of hearing level from assumed normal, 2) apportionment of new hearing injury in final hearing, and 3) a change in disability rating. We evaluated for significant differences and correlations between the values obtained by each method. RESULTS: There was a significant difference between the results by the methods 1 and 2. The disability rating by the method 2 showed good correlations with those assessed by the methods 1 and 3. CONCLUSION: When considering aggravation of disability in hearing, the method 2 could be a good alternative when the standard method 3 is inappropriate.
Disability Evaluation ; Hearing ; Hearing Loss

BACKGROUND AND OBJECTIVES: According to the correlation between hearing injury and McBride disability rating presented by previous studies, there are over/underestimated cases particularly in the 40 dB hearing range compared to other ranges. In this study, we reviewed the overestimated and underestimated data and propose a complementation scheme for a disability rating system by using the linear regression analysis. SUBJECTS AND METHOD: For the past 14 years, we have provided legal advisory for 121 cases of hearing injury, for which disability had to be rated. We reviewed all but excluded 11 cases for the aggravation of disability. A regression equation was produced from a linear regression analysis that used the percent of hearing handicap (AAO-HNS/AMA-1979 formula) as an independent variable (x) and McBride disability rating (%) as a dependent variable (y), following the Pearson correlation test. Iterative calculation was performed for overestimated (18) and underestimated (8) cases. RESULTS: Appropriate disability ratings were 14% for the cases overestimated to 20% and 11% for those underestimated to 5%. Appropriate disability ratings for the 20% of overestimated cases were changed to 14%, and for the 5% of the underestimated cases, the disability ratinb 11%. Iterative calculation showed that the Pearson correlation index was improved from 0.8866 to 0.9065 and the determination coefficient of regression analysis (adjusted R-square) was improved from 0.784 to 0.8202. CONCLUSION: The common range of hearing injury, which falls between 30-40 dB corresponds to the percentage of hearing handicap of 7.5-22.5%. A fairer assessment of ability rating would be possible by complementing some parts of this hearing range.
Complement System Proteins* ; Disability Evaluation ; Hearing Loss ; Hearing* ; Jurisprudence ; Linear Models* ; Regression Analysis*

Purpose: We aimed to assess the characteristics of patients with concurrent tinnitus and hyperacusis, determine the best audiological criteria for predicting hyperacusis, and confirm whether objective evidence of changes in the brain exists. Materials and Methods: The medical records of patients with tinnitus who visited the hospital between March 2020 and December 2021 were reviewed. Data on accompanying hyperacusis, audiological profiles, and questionnaires including the Tinnitus Handicap Inventory (THI), Beck Depression Inventory, and numerical rating scale were analyzed. Resting-state quantitative electroencephalography (qEEG) using power spectral density (PSD) and event-related spectral perturbation (ERSP) were performed to objectively quantify changes in the brain. Results: A total of 194 patients were analyzed. Among them, 51 (26.3%) reported combined subjective hyperacusis with tinnitus.However, the proportions widely varied from 7.4% to 68.4% based on three audiological criteria for assessment. A higher score on the THI questionnaire was independently associated with the co-occurrence of tinnitus and hyperacusis. Fair agreement was observed between subjective hyperacusis and the audiological criterion based on a loudness discomfort level (LDL) of ≤90 dB at two or more frequencies for the diagnosis of hyperacusis. An increased beta-PSD and decreased levels of gamma-PSD, all-ERSP, and delta-ERSP were observed in patients with hyperacusis (p<0.05). Conclusion Patients with co-occurring tinnitus and hyperacusis had more severe tinnitus distress. An LDL of ≤90 dB at two or more frequencies may be applicable to predict accompanying hyperacusis in subjects with tinnitus, and qEEG also provides more objective information.

Purpose: We aimed to assess the characteristics of patients with concurrent tinnitus and hyperacusis, determine the best audiological criteria for predicting hyperacusis, and confirm whether objective evidence of changes in the brain exists. Materials and Methods: The medical records of patients with tinnitus who visited the hospital between March 2020 and December 2021 were reviewed. Data on accompanying hyperacusis, audiological profiles, and questionnaires including the Tinnitus Handicap Inventory (THI), Beck Depression Inventory, and numerical rating scale were analyzed. Resting-state quantitative electroencephalography (qEEG) using power spectral density (PSD) and event-related spectral perturbation (ERSP) were performed to objectively quantify changes in the brain. Results: A total of 194 patients were analyzed. Among them, 51 (26.3%) reported combined subjective hyperacusis with tinnitus. However, the proportions widely varied from 7.4% to 68.4% based on three audiological criteria for assessment. A higher score on the THI questionnaire was independently associated with the co-occurrence of tinnitus and hyperacusis. Fair agreement was observed between subjective hyperacusis and the audiological criterion based on a loudness discomfort level (LDL) of ≤90 dB at two or more frequencies for the diagnosis of hyperacusis. An increased beta-PSD and decreased levels of gamma-PSD, all-ERSP, and delta-ERSP were observed in patients with hyperacusis (p<0.05). Conclusion Patients with co-occurring tinnitus and hyperacusis had more severe tinnitus distress. An LDL of ≤90 dB at two or more frequencies may be applicable to predict accompanying hyperacusis in subjects with tinnitus, and qEEG also provides more objective information.

As a consequence of the incomplete resolution of embryologic mammary ridges, ectopic breast tissue can be present anywhere along the "milk line", including the axillary region. Aberrant breast tissue can develop with any disease that affects the normal breast, including a breast carcinoma. A carcinoma of aberrant breast tissue is rare, but should still be investigated and treated properly with respect to other breast cancers in the embryonic milk-line. Herein is reported our recent experience of a carcinoma originating from aberrant breast tissue in the right axilla. An abnormal nodule around the periphery of the normal breast should be suspected as a breast carcinoma and differential diagnosis and properly treated.
Axilla ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Diagnosis, Differential

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disease. Polycystic liver disease is commonly observed in ADPKD but rarely has it been associated with a choledochal cyst. We report a case of a choledochal cyst with ADPKD in a 60-year-old female patient with ADPKD and concomitant chronic renal failure who was admitted because of acute deterioration of kidney function due to poor oral intake. There was no history of a biliary disorder and her kidney function recovered promptly after fluid replacement. Non-enhanced computed tomography was performed to evaluate ADPKD and revealed numerous cysts in both kidneys and liver. It also showed fusiform dilatation of the extrahepatic bile ducts, a finding indicative of a choledochal cyst. Liver function was within the normal range and there was no evidence of extrahepatic biliary obstruction. Magnetic resonance cholangiopancreatography confirmed the diagnosis of a type I choledochal cyst combined with ADPKD.
Bile Ducts, Extrahepatic ; Cholangiopancreatography, Magnetic Resonance ; Choledochal Cyst ; Cysts ; Dilatation ; Female ; Humans ; Kidney ; Kidney Failure, Chronic ; Liver ; Liver Diseases ; Polycystic Kidney, Autosomal Dominant ; Reference Values

The Fas (TNF receptor superfamily, member 6) (FAS)/FAS ligand (FASLG) interaction plays a central role in the regulation of programmed cell death. FAS and FASLG polymorphisms in promoter regions affect transcriptional activities. To investigate whether FAS and FASLG polymorphisms are associated with the development and clinical phenotypes of stroke, 2 promoter single nucleotide polymorphisms (SNPs) in FAS (rs1800682, -670C/T) and FASLG (rs763110, -844C/T) were selected and genotyped by direct sequencing in 220 stroke patients [107 ischemic stroke (IS), 77 intracerebral hemorrhage (ICH), and 36 subarachnoid hemorrhage (SAH)] and 369 control subjects. For the analysis of clinical symptoms, all stroke patients were divided into 3 clinical phenotypes according to the respective results of the National Institutes of Health Stroke Survey (NIHSS) and the Modified Barthel Index (MBI) and the presence or absence of complex regional pain syndrome (CRPS). The SNPStats, SNPAnalyzer, and Helixtree programs were used to analyze the genetic data. Multiple logistic regression models (codominant, dominant, and recessive) were used to estimate odds ratios (ORs), 95% confidence intervals (CIs), and p-values. The promoter SNP rs1800682 was associated with stroke in the codominant (OR=0.48, 95% CI=0.25-0.94, p=0.04) and dominant models (OR=0.51, 95% CI=0.30-0.87, p=0.011). However, a FASLG SNP (rs763110) was not in Hardy-Weinberg equilibrium (p<0.05). In the analysis of stroke types, rs1800682 was associated with IS in the codominant (OR=0.30, 95% CI=0.12-0.74, p=0.025), dominant (OR=0.44, 95% CI=0.23-0.88, p=0.018), and recessive models (OR=0.45, 95% CI=0.21-0.99, p=0.042). The genotype frequencies of rs1800682 were different between ICH and controls in the dominant model (OR=0.49, 95% CI=0.26-0.94, p=0.031) but not between SAH and controls. In the analysis of clinical symptoms, however, rs1800682 was not related to the 3 clinical phenotypes (NIHSS, MBI, and CRPS). These results suggest that a promoter SNP (rs1800682, -670C/T) in FAS may be associated with the development of stroke in the Korean population.
Cell Death ; Cerebral Hemorrhage ; Genotype ; Humans ; Logistic Models ; National Institutes of Health (U.S.) ; Odds Ratio ; Phenotype ; Polymorphism, Single Nucleotide ; Promoter Regions, Genetic ; Stroke ; Subarachnoid Hemorrhage

Anisakiasis is a parasitic disease following eating raw fishes infected with Anisakis larvae. The endoscopic features of the gastric mucosa are edema, erosion, ulceration and hemorrhage. Gastric anisakiasis forming submucosal tumor is rare. Twenty six-year-old man who complained of severe epigastric pain was admitted. The pain began approximately three hours after eating slices of raw Astroconger myriaster. Gastric endoscopy revealed a submucosal tumor with central erosion on the gastric fundus. Endoscopic ultrasonography detected a thickening of the gastric wall made of mainly thickened submucosal layer. Abdominal CT scan showed a gastric mass lesion with hypodensity in the gastric fundus and subsequently wedge resection was performed. The pathologic finding of the resected mass was eosinophilic abscess in the submucosal layer. We report a case of gastric submucosal tumor which seems to be caused by Anisakis, with a review of relevant literature.
Abscess ; Anisakiasis ; Anisakis* ; Eating ; Edema ; Endoscopy ; Endosonography ; Eosinophils ; Fishes ; Gastric Fundus ; Gastric Mucosa ; Hemorrhage ; Larva ; Parasitic Diseases ; Tomography, X-Ray Computed ; Ulcer

Human angiotensin-converting enzyme 2 (hACE2) has recently received a great attention due to it play a critical role as SARS-CoV receptor in the infection of human body. However, no further analysis for gene regulation has been performed in target tissues of model mice during hACE2 overproduction. To characterize changes in global gene expression in the hearts and kidneys of rtTA/hACE2 double transgenic (dTg) mice in response to hACE2 overexpression, total RNA extracted from these tissues from dTg mice after doxycycline (Dox) treatment was hybridized to oligonucleotide microarrays. Briefly, dTg mice were generated by cross-mating pα-MHC/rtTA Tg mice with pTRE/hACE2 Tg mice. The expression level of hACE2 protein was determined to be high in hearts, kidneys, and brains of dTg mice, whereas lung, liver, and testis tissues expressed low levels. The level of hACE2 was significantly enhanced in hearts and kidneys of the Dox+dTg group compared to that in Vehicle+dTg mice although consistent levels of mouse ACE2 (mACE2) remained in the same tissues. Based on the microarray analysis of heart tissue, 385 genes were differentially expressed, including 168 upregulated and 217 downregulated, when comparing non-Tg and Vehicle+dTg mice, whereas 216 genes were differentially expressed, including 136 upregulated and 80 downregulated, between Vehicle+dTg and Dox+dTg mice. In the kidneys, 402 genes were differentially expressed, including 159 upregulated and 243 downregulated, between non-Tg and Vehicle+dTg mice. Dox-treated dTg mice exhibited the differential expression of 4735 genes including 1636 upregulated and 3109 downregulated. Taken together, these findings suggested that several functional groups and individual genes can be considered biomarkers that respond to hACE2 overexpression in dTg mice. Moreover, our results provided a lot of useful information to predict physiological responses when these dTg mice are applied as a susceptible model for novel coronavirus (SARS-CoV, COVID-19) in both vaccine and drug development.