BACKGROUND: The role of extended-spectrum beta-lactamase (ESBL)-producing or multidrug-resistant (MDR) organisms in patients with sepsis secondary to urinary traction infection (UTI) has not been investigated extensively in the intensive care unit (ICU) setting. METHODS: Patients with UTI sepsis admitted to the ICU were retrospectively enrolled in this study (January 2009-December 2012). We investigated the impact of ESBL-producing and ESBL-negative MDR organisms on hospital outcome. RESULTS: In total, 94 patients were enrolled (median age, 73.0 years; female, 81.9%), and ESBL-producing and ESBL-negative MDR organisms accounted for 20.2% (n = 19) and 30.9% (n = 29), respectively. Both patients with ESBL-producing and ESBL-negative MDR organisms were more likely to experience a delay in adequate antibiotic therapy than those with non-ESBL/non-MDR organisms (p < 0.001 and p = 0.032, respectively). However, only patients with ESBL-producing organisms showed a higher mortality rate (ESBL vs. ESBL-negative MDR vs. non-ESBL/non-MDR, 31.6% vs. 10.3%.vs. 10.9%, respectively). In multivariate analyses, ESBL production was significantly associated with hospital mortality (odds ratio, 11.547; 95micro confidence interval, 1.047-127.373), and prior admission was a significant predictor of ESBL production. CONCLUSIONS: Although both ESBL-producing and ESBL-negative MDR organisms are associated with delayed administration of appropriate antibiotics, only ESBL production is a significant predictor of hospital mortality among patients with UTI sepsis in the ICU setting.
Anti-Bacterial Agents ; beta-Lactamases* ; Drug Resistance, Multiple* ; Female ; Hospital Mortality ; Humans ; Intensive Care Units* ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Sepsis* ; Urinary Tract ; Urinary Tract Infections

Neurogenesis persists in restricted regions of the adult brain, including the subventricular zone (SVZ). Adult neural stem cells (NSCs) in the SVZ proliferate and give rise to new neurons and glial cells depending on intrinsic and environmental cues. Among the multiple factors that contribute to the chemical, physical, and mechanical components of the neurogenic niche, we focused on the composition of the extracellular matrix (ECM) of vasculature and fractones in the SVZ. The SVZ consists of ECM-rich blood vessels and fractones during development and adulthood, and adult neural stem/progenitor cells (NS/PCs) preferentially attach to the laminin-rich basal lamina. To examine the ECM preference of adult NS/PCs, we designed a competition assay using cell micropatterning. Although both laminin and collagen type IV, which are the main components of basal lamina, act as physical scaffolds, adult NS/PCs preferred to adhere to laminin over collagen type IV. Interestingly, the ECM preference of adult NS/ PCs could be manipulated by chemokines such as stromal-derived factor 1 (SDF1) and α6 integrin. As SDF1 re-routes NSCs and their progenitors toward the injury site after brain damage, these results suggest that the alteration in ECM preferences may provide a molecular basis for contextdependent NS/PC positioning.

Neurogenesis persists in restricted regions of the adult brain, including the subventricular zone (SVZ). Adult neural stem cells (NSCs) in the SVZ proliferate and give rise to new neurons and glial cells depending on intrinsic and environmental cues. Among the multiple factors that contribute to the chemical, physical, and mechanical components of the neurogenic niche, we focused on the composition of the extracellular matrix (ECM) of vasculature and fractones in the SVZ. The SVZ consists of ECM-rich blood vessels and fractones during development and adulthood, and adult neural stem/progenitor cells (NS/PCs) preferentially attach to the laminin-rich basal lamina. To examine the ECM preference of adult NS/PCs, we designed a competition assay using cell micropatterning. Although both laminin and collagen type IV, which are the main components of basal lamina, act as physical scaffolds, adult NS/PCs preferred to adhere to laminin over collagen type IV. Interestingly, the ECM preference of adult NS/ PCs could be manipulated by chemokines such as stromal-derived factor 1 (SDF1) and α6 integrin. As SDF1 re-routes NSCs and their progenitors toward the injury site after brain damage, these results suggest that the alteration in ECM preferences may provide a molecular basis for contextdependent NS/PC positioning.

Hepatoid carcinoma is histologically similar to hepatocelluar carcinoma and produce alfa-fetoprotein. Ovarian hepatoid carcinoma is extremely rare whether primary or metastatic. We experienced one case of primary ovarian hepatoid carcinoma. In this case report, we present histologic findings, therapeutic modalities of primary hepatoid carcinoma with review of literatures.
alpha-Fetoproteins ; Female ; Ovary

Good's syndrome is an acquired immunodeficiency state associated with thymoma. It is characterized by recurrent infection, autoimmune disease, and immunologic abnormality. The insufficient immunity can be managed by intravenous immunoglobulin (IVIG) replacement therapy. We describe 2 patients who presented with Pneumocystis jiroveci pneumonia and Cytomegalovirus pneumonia after thymectomy for a thymoma. Immunologic study revealed hypogammaglobulinemia with very low B-cell count, consistent with Good's syndrome. They were successfully treated with trimethoprim/sulfamethoxazole and gancyclovir respectively, and they are all well without additional infections, receiving regular IVIG replacement.
Agammaglobulinemia ; Autoimmune Diseases ; B-Lymphocytes ; Cytomegalovirus ; Ganciclovir ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Lung* ; Opportunistic Infections ; Pneumocystis jirovecii ; Pneumonia ; Thymectomy ; Thymoma

Background/Aims: Studies on the effectiveness of public health measures to prevent respiratory virus transmission in real-world settings are lacking. We investigated the effectiveness of universal mask use and adherence to other personal preventive measures on the changing viral respiratory infection patterns during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Data were extracted from the South Korean National Respiratory Virus Sentinel Surveillance System. During the COVID-19 pandemic, a cross-sectional survey on adherence to personal preventive measures was conducted. Additionally, the number of subway passengers was analyzed to estimate physical distancing compliance. Results: During the pandemic, adherence to personal preventive measures significantly increased, particularly indoors and on public transportation. Respiratory virus trends were compared based on laboratory surveillance data of 47,675 patients with acute respiratory infections (2016 to 2020). The 2019 to 2020 influenza epidemic ended within 3 weeks, from the epidemic peak to the epidemic end, quickly ending the inf luenza season; with a 1.8- to 2.5-fold faster decline than in previous seasons. Previously, the overall respiratory virus positivity rate remained high after the influenza seasons had ended (47.7% to 69.9%). During the COVID-19 pandemic, this positive rate, 26.5%, was significantly lower than those in previous years. Hospital-based surveillance showed a decreased number of hospitalized patients with acute viral respiratory illnesses. Conclusions This study suggests that high compliance to the use of personal preventive measures in public might reduce the incidence of all respiratory virus infections and its hospitalization rates, with no additional quarantine, isolation, or contact screening.

BACKGROUND/AIMS: Inhaled corticosteroids (ICS) are a treatment of choice for eosinophilic airway diseases, but their efficacy for other causes of chronic cough is controversial. METHODS: We conducted a prospective observational study to determine the ICS efficacy and clinical predictors of response to ICS in patients with upper airway cough syndrome (UACS) or unexplained chronic cough (UCC). Sixty-eight patients with UACS and 33 patients with UCC (duration of cough ≥ 8 weeks) were treated with ICS: 250 µg of fluticasone propionate or 400 µg of budesonide twice a day at physician's discretion. They were followed after 2 weeks to assess persistent cough which was measured as 0% to 100% compared with baseline cough frequency. RESULTS: The median grade of persistent cough after 2-week ICS treatment was 40% (interquartile range [IQR], 10 to 70) in UACS and was 50% (IQR, 20 to 70) in UCC. The only adverse event was infrequent, mild hoarse voice (five UACS and one UCC). Long duration of cough (≥ 52 weeks) and cough not aggravated by cold air exposure were predictors of a poorer response to short course ICS treatment (logistic regression analysis, p = 0.018 and p = 0.031, respectively). However, prolonged treatment with ICS more than 2 weeks was more effective in patients with long cough duration (≥ 52 weeks). CONCLUSIONS Short course ICS treatment has modest efficacy on UACS and UCC without significant adverse events. Duration of cough and cough triggered by cold air exposure were the clinical factors associated with ICS response. Extended treatment with ICS may be beneficial in patients with long duration of cough.

Background/Aims: Studies on the effectiveness of public health measures to prevent respiratory virus transmission in real-world settings are lacking. We investigated the effectiveness of universal mask use and adherence to other personal preventive measures on the changing viral respiratory infection patterns during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Data were extracted from the South Korean National Respiratory Virus Sentinel Surveillance System. During the COVID-19 pandemic, a cross-sectional survey on adherence to personal preventive measures was conducted. Additionally, the number of subway passengers was analyzed to estimate physical distancing compliance. Results: During the pandemic, adherence to personal preventive measures significantly increased, particularly indoors and on public transportation. Respiratory virus trends were compared based on laboratory surveillance data of 47,675 patients with acute respiratory infections (2016 to 2020). The 2019 to 2020 influenza epidemic ended within 3 weeks, from the epidemic peak to the epidemic end, quickly ending the inf luenza season; with a 1.8- to 2.5-fold faster decline than in previous seasons. Previously, the overall respiratory virus positivity rate remained high after the influenza seasons had ended (47.7% to 69.9%). During the COVID-19 pandemic, this positive rate, 26.5%, was significantly lower than those in previous years. Hospital-based surveillance showed a decreased number of hospitalized patients with acute viral respiratory illnesses. Conclusions This study suggests that high compliance to the use of personal preventive measures in public might reduce the incidence of all respiratory virus infections and its hospitalization rates, with no additional quarantine, isolation, or contact screening.

BACKGROUND: Epigallocatechin-3-gallate (EGCG), a major biologically active component of green tea, has anti-cancer activity in human and animal models. We investigated the schedule-dependent effect of EGCG and paclitaxel on growth of NCI-H460 non-small cell lung cancer cells. METHODS: To investigate the combined effect of EGCG (E) and paclitaxel (P), combination indices (CIs) were calculated, and cell cycle analysis was performed. For the effect on cell apoptosis, western blot analysis was also performed. RESULTS: CI analysis demonstrated that both concurrent and sequential E --> P treatments had antagonistic effects (CIs >1.0), but sequential P --> E had synergistic effects (CIs <1.0), on the growth inhibition of NCI-H460 cells. In the cell cycle analysis, although paclitaxel induced G2/M cell cycle arrest and increased the sub-G1 fraction, concurrent EGCG and paclitaxel treatments did not have any additive or synergistic effects compared with the paclitaxel treatment alone. However, western blot analysis demonstrated that sequential P --> E treatment decreased the expression of Bcl-2 and procaspase-3 and increased poly(ADP-ribose) polymerase (PARP) cleavage; while minimal effects were seen with concurrent or sequential E --> P treatments. CONCLUSION: Concurrent or sequential E --> P treatment had opposite effects to P --> E treatment, where P --> E treatment showed a synergistic effect on growth inhibition of NCI-H460 cells by inducing apoptosis. Thus, the efficacy of EGCG and paclitaxel combination treatment seems to be schedule-dependent.
Apoptosis ; Blotting, Western ; Carcinoma, Non-Small-Cell Lung ; Caspase 3 ; Cell Cycle ; Cell Cycle Checkpoints ; Humans ; Lung Neoplasms ; Models, Animal ; Paclitaxel* ; Poly(ADP-ribose) Polymerases ; Tea

BACKGROUND/AIMS: The relationship between nonpulmonary organ failure and the development of acute respiratory distress syndrome (ARDS) in patients with sepsis has not been well studied. METHODS: We retrospectively reviewed the medical records of patients with septic bacteremia admitted to the medical intensive care unit (ICU) of a tertiary academic hospital between January 2013 and December 2016. RESULTS: The study enrolled 125 patients of median age 73.0 years. Urinary (n = 47), hepatobiliary (n = 30), and pulmonary infections (n = 28) were the most common causes of sepsis; the incidence of ARDS was 17.6%. The total number of nonpulmonary organ failures at the time of ICU admission was higher in patients with ARDS than in those without (p = 0.011), and the cardiovascular, central nervous system (CNS), and coagulation scores were significantly higher in ARDS patients. On multivariate analysis, apart from pneumonia sepsis, the CNS (odds ratio [OR], 1.917; 95% confidence interval [CI], 1.097 to 3.348) and coagulation scores (OR, 2.669; 95% CI, 1.438 to 4.954) were significantly associated with ARDS development. The 28-day and in-hospital mortality rates were higher in those with ARDS than in those without (63.6 vs. 8.7%, p < 0.001; 72.7% vs. 11.7%, p < 0.001), and ARDS development was found to be an independent risk factor for 28-day mortality. CONCLUSIONS: Apart from pneumonia, CNS dysfunction and coagulopathy were significantly associated with ARDS development, which was an independent risk factor for 28-day mortality.
Bacteremia ; Central Nervous System ; Hospital Mortality ; Humans ; Incidence ; Intensive Care Units ; Medical Records ; Mortality ; Multivariate Analysis ; Pneumonia ; Respiratory Distress Syndrome, Adult* ; Retrospective Studies ; Risk Factors* ; Sepsis