Coronary artery fistula is a rare congenital anomaly. Most patients with this anomaly are asymptomatic, but some may develop heart failure, myocardial ischemia or arrhythmias. We report a case of a patient who presented with myocardial ischemia secondary to persistent Thebesian veins. Coronary angiography demonstrated a marked capillary blush draining into the left ventricular cavity through multiple microfistulae from the left anterior descending artery, left circumflex artery and right coronary artery. The patient was discharged without chest pain and was medically maintained with a beta-blocker and angiotensin converting enzyme inhibitor.
Arrhythmias, Cardiac ; Arteries ; Arteriovenous Fistula ; Capillaries ; Chest Pain ; Coronary Angiography ; Coronary Vessel Anomalies ; Coronary Vessels ; Fistula ; Heart Failure ; Humans ; Myocardial Ischemia ; Peptidyl-Dipeptidase A ; Veins

The perivascular space (PVS) of the brain, also known as Virchow-Robin space, consists of cerebrospinal fluid and connective tissues bordered by astrocyte endfeet. The PVS, in a word, is the route over the arterioles, capillaries, and venules where the substances can move. Although the PVS was identified and described first in the literature approximately over 150 years ago, its importance has been highlighted recently after the function of the waste clearing system of the interstitial fluid and wastes was revealed. The PVS is known to be a microscopic structure detected using T2-weighted brain MRI as dot-like hyperintensity lesions when enlarged. Although until recently regarded as normal with no clinical consequence and ignored in many circumstances, several studies have argued the association of an enlarged PVS with neurodegenerative or other diseases. Many questions and unknown facts about this structure still exist; we can only assume that the normal PVS functions are crucial in keeping the brain healthy. In this review, we covered the history, anatomy, pathophysiology, and MRI findings of the PVS; finally, we briefly touched upon the recent trials to better visualize the PVS by providing a glimpse of the brain fluid dynamics and clinical importance of the PVS.

Of total 1,438 specimens of patients with diarrhea in Seoul, 2011, 217 samples (15%) were found pathogenic Escherichia coli that included 192 strains (89%) of enterotoxigenic E. coli (ETEC) and enteroaggregative E. coli (EAEC). The highest isolation rate for ETEC and EAEC was found in August and September. Sixty two pathogenic E. coli strains (34 ETEC and 28 EAEC strains) were selected from 175 strains (94 ETEC and 81 EAEC strains) isolated in August and September. Of 94 strains characterized for ETEC phenotype, 76 (81%) expressed heat-stable toxin (ST) only. Antimicrobial susceptibility test was carried out by using sixteen types of antibiotics. A high level of antimicrobial resistance to tetracycline (57%), ampicillin and ticarcillin (54%) was observed among EAEC isolates while the highest resistance rate of ETEC was found for nalidixic acid (47%), followed by tetracycline (32%). As to the antimicrobial susceptibility test, EAEC showed the complicated multi-drug resistant patterns in which the resistance was higher than ETEC. Pulsed-field gel electrophoresis (PFGE) was carried out to examine the genetic relatedness among ETEC and EAEC isolates. Except for 11 strains, 51 strains were divided by eight pulsotypes. In PFGE analysis, isolates from foodborne disease outbreaks in August and September 2011 showed close relation.
Ampicillin ; Anti-Bacterial Agents ; Diarrhea ; Disease Outbreaks ; Electrophoresis, Gel, Pulsed-Field ; Enterotoxigenic Escherichia coli ; Escherichia coli ; Foodborne Diseases ; Humans ; Nalidixic Acid ; Phenotype ; Tetracycline ; Ticarcillin

Clostridium perfringens food poisoning ranks among the most common gastrointestinal diseases in developed countries. In Korea, C. perfringens food poisoning gradually increases. Using PCR, 72 strains of C. perfringens isolated in Seoul, 2013 were tested for the presence of toxin genes. Of the tested strains, 32 isolates carried the cpe gene, 37 isolates carried the cpb2 gene and 3 isolates carried the cpe and cpb2 genes, respectively. 32 cpe-positive strains were isolated from the food poisoning patient, whereas among 37 cpb2-positive strains, 22 strains were isolated from asymptomatic person. To investigate epidemiological relationship between the isolates, Pulsed-filed gel electrophoresis (PFGE) was performed. The genetic relatedness of the isolates ranged from 55.9% to 100% and 47 distinct PFGE profiles were observed. The results show that the cpe-positive outbreak strains showed close genetic relation, whereas the cpb2-positive isolates revealed a wide genetic diversity.
Clostridium perfringens* ; Developed Countries ; Electrophoresis ; Foodborne Diseases* ; Gastrointestinal Diseases ; Genetic Variation ; Humans ; Korea ; Molecular Epidemiology* ; Polymerase Chain Reaction ; Seoul

BACKGROUND: Under certain conditions, exertional headaches may reflect coronary ischemia. CASE REPORT: A 44-year-old woman developed intermittent exercise-induced headaches with chest tightness over a period of 10 months. Cardiac catheterization followed by acetylcholine provocation demonstrated a right coronary artery spasm with chest tightness, headache, and ischemic effect of continuous electrocardiography changes. The patient's headache disappeared following intra-arterial nitroglycerine injection. CONCLUSIONS: A coronary angiogram with provocation study revealed variant angina and cardiac cephalalgia, as per the International Classification of Headache Disorders (code 10.6). We report herein a patient with cardiac cephalalgia that manifested as reversible coronary vasospasm following an acetylcholine provocation test.
Acetylcholine ; Adult ; Angina Pectoris ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Vasospasm ; Coronary Vessels ; Electrocardiography ; Female ; Headache ; Headache Disorders ; Humans ; Ischemia ; Nitroglycerin ; Spasm ; Thorax

PURPOSE: This study was conducted to investigate the neurocognitive functioning of children with intracranial germ cell tumor (IGCT) prior to receiving proton beam therapy (PBT), and to identify differential characteristics of their neurocognitive functioning depending on tumor location. As a secondary object of this study, neurocognitive functions were followed up at 1-2 years after PBT to examine early post-treatment changes. MATERIALS AND METHODS: Between 2008 and 2014, 34 childrenwith IGCT treatedwho received PBT atNational Cancer Center, Korea were enrolled in this study. Standardized neurocognitive tests of intelligence, memory, and executive functioning were performed with baseline psychological assessments using the Child Behavior Checklist (CBCL). Follow-up assessments after PBT were conducted in 20 patients (T2). The results were analyzed based on the locations of tumors, which included the suprasellar, pineal gland, basal ganglia, and bifocal regions. RESULTS: The neurocognitive function of IGCT patients was significantly lower than that of the normal population in performance intelligence quotient (p=0.041), processing speed (p=0.007), memory (p < 0.001), and executive functioning (p=0.010). Patients with basal ganglia tumors had significantly lower scores for most domains of neurocognitive functioning and higher scores for CBCL than both the normal population and patients with IGCT in other locations. There was no significant change in neurocognitive function between T1 and T2 for all types of IGCT patients in first 1-2 years after PBT. CONCLUSION: Tumor location significantly affects the neuropsychological functioning in patients with IGCT. Neuropsychological functioning should be closely monitored from the time of diagnosis in IGCT patients.
Basal Ganglia ; Brain Neoplasms ; Checklist ; Child Behavior ; Child* ; Cognition ; Diagnosis ; Follow-Up Studies ; Germ Cells* ; Humans ; Intelligence ; Korea ; Memory ; Neoplasms, Germ Cell and Embryonal* ; Pineal Gland ; Proton Therapy

Biopsy ; Classification ; Dataset ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography

BACKGROUND: Antimicrobial resistance of Neisseria gonorrhoeae has become a serious problem worldwide, and ceftriaxone non-susceptible isolates have been recently reported from Japan and Europe. In this study, we evaluated the antimicrobial susceptibilities and molecular epidemiological characteristics of isolates from Korea in 2013. METHODS: Sixty strains of N. gonorrhoeae were collected from Korean patients and prostitutes. Antimicrobial susceptibility was tested by the agar dilution and disk diffusion methods. N. gonorrhoeae multi-antigen sequence typing (NG-MAST) was performed in order to determine the molecular epidemiologic relatedness. RESULTS: All of isolates were non-susceptible to penicillin G and tetracycline, and the rate of ciprofloxacin-resistant isolates was 95% in 2013. The MICs of ceftriaxone were within the susceptible range for all isolates, but one isolate non-susceptible to cefixime (MIC=0.5 microg/mL) was encountered. The isolates with decreased susceptibility (MIC< or =0.12 microg/mL) to cefixime or ceftriaxone accounted for 10% and 14% of the isolates tested, respectively. In NG-MAST analysis, 40 different STs were encountered among the 59 isolates. Isolates that belonged to tbpB110 showed higher cefixime and ceftriaxone MICs (0.12-0.5 microg/mL) as well as cefixime resistance. CONCLUSION: Most of the N. gonorrhoeae isolates showed susceptibility to spectinomycin and cephalosporins. Due to the emergence of isolates that are non-susceptible to cefixime and the prevalence of isolates with the tbpB110 allele belonging to ST1407, which cause cefixime and ceftriaxone treatment failure in successful global clones of N. gonorrhoeae, a continuous nationwide antimicrobial surveillance program is required to monitor the emergence of cephalosporin resistance in N. gonorrhoeae.

Flt3 Ligand (FL) and IL-6 are multifunctional cytokines implicated in normal hematopoiesis and ex vivo expansion of hematopoietic stem cells. Retroviral vectors are useful for stable expression of genes in many cells. Here, we aimed to produce retroviral vectors directing expression of human FL and IL-6 genes. Recombinant retroviral vectors containing human genes for FL and IL-6 were constructed using a retroviral vector pLXSN. Recombinant retroviruses were produced from GP2-293 cells with the aid of pseudo-envelope protein gene VSV-G, and efficiently transduced to a mouse stromal cell line OP9. Genetically modified OP9 cells clearly showed expression of human FL or IL-6 gene at the mRNA level determined by RT-PCR. Based on the results from ELISA, human FL and IL-6 were detected in the cell culture medium of OP9/FL and OP9/IL-6 cells, respectively. As the recombinant human FL and IL-6 proteins are successfully produced and secreted to the culture medium, this system can be useful in future application such as ex vivo expansion of hematopoietic stem cells and differentiation of embryonic stem cells.
Animals ; Cell Culture Techniques ; Cytokines ; Embryonic Stem Cells ; Enzyme-Linked Immunosorbent Assay ; Hematopoiesis ; Hematopoietic Stem Cells ; Humans* ; Interleukin-6* ; Mice* ; Retroviridae* ; RNA, Messenger ; Stromal Cells* ; Zidovudine

Stem cell factor (SCF) is an early-acting cytokine inducing proliferative synergy with other cytokines in hematopoietic cells. We earlier showed that p21 was synergistically induced in SCF synergy and the p44/42 MAPK pathway was essential for the transcriptional control of p21. SCF synergy accompanies protein synthesis. p70S6K implicated in translational control in many other systems has not been shown in SCF synergy induced system. GM-CSF dependent human cell line MO7e was stimulated with GM-CSF with SCF, and investigated activation of p70S6K by using phospho-specific antibody. A possible contribution of p70S6K to SCF synergy was examined by measuring p21 induction as a model system. p70S6K was slightly activated by GM-CSF alone and markedly activated by SCF alone. Combined stimulation with these two cytokines synergistically activated p70S6K resulting in persistent activation. Addition of the pathway- specific inhibitors for PI3K or FRAP/TOR, two upstream pathways of p70S6K resulted in abolishment of p70S6K phosphorylation and also significant reduction of p21 protein level. These data suggest that synergistically activated p70S6K by GM-CSF plus SCF involves, at least in part, protein translational control including regulation of p21 protein.
1-Phosphatidylinositol 3-Kinase/metabolism ; Drug Synergism ; Enzyme Activation ; Granulocyte-Macrophage Colony-Stimulating Factor/*pharmacology ; Hematopoietic Stem Cells/*enzymology ; Human ; Phosphorylation/drug effects ; Protein-Serine-Threonine Kinases/metabolism ; Ribosomal Protein S6 Kinases, 70kD/antagonists & inhibitors/*metabolism ; Stem Cell Factor/*pharmacology ; Tacrolimus Binding Protein 1A/metabolism