Background: and PurposeMild cognitive impairment (MCI) is a condition with diverse clinical outcomes and subgroups. Here we investigated the topographic distribution of tau in vivo using the positron emission tomography (PET) tracer [18F]THK5351 in MCI subgroups. Methods: This study included 96 participants comprising 38 with amnestic MCI (aMCI), 21 with nonamnestic MCI (naMCI), and 37 with normal cognition (NC) who underwent 3.0-T MRI, [18F]THK5351 PET, and detailed neuropsychological tests. [18F]flutemetamol PET was also performed in 62 participants. The aMCI patients were further divided into three groups: 1) verbal-aMCI, only verbal memory impairment; 2) visual-aMCI, only visual memory impairment; and 3) both-aMCI, both visual and verbal memory impairment. Voxel-wise statistical analysis and region-of-interest -based analyses were performed to evaluate the retention of [18F]THK5351 in the MCI subgroups. Subgroup analysis of amyloid-positive and -negative MCI patients was also performed. Correlations between [18F]THK5351 retention and different neuropsychological tests were evaluated using statistical parametric mapping analyses. Results: [18F]THK5351 retention in the lateral temporal, mesial temporal, parietal, frontal, posterior cingulate cortices and precuneus was significantly greater in aMCI patients than in NC subjects, whereas it did not differ significantly between naMCI and NC participants. [18F] THK5351 retention was greater in the both-aMCI group than in the verbal-aMCI and visualaMCI groups, and greater in amyloid-positive than amyloid-negative MCI patients. The cognitive function scores were significantly correlated with cortical [18F]THK5351 retention. Conclusions [18F]THK5351 PET might be useful for identifying distinct topographic patterns of [18F]THK5351 retention in subgroups of MCI patients who are at greater risk of the progression to Alzheimer's dementia.

Orientia tsutsugamushi (O. tsutsugamushi), which is endemic to an Asia-Pacific region, has increased its incidence and caused annually around 10 thousand patients infected with scrub typhus in Korea in the past several years. In the present study, we isolated 44 O. tsutsugamushi from the patients with febrile illness accompanied with or without an eschar in Gyeongsangnam-do, Korea. These isolates were characterized by genetic analysis of the major outer membrane protein, the 56-kDa type-specific antigen (tsa56), which is unique to O. tsutsugamushi. Two types of sequences of tsa56, designated by JJ1 and JJ2, were determined from 37 and 7 isolates of the 44 isolates, respectively. JJ1 and JJ2 showed 74.7~90.8% identity in nucleotide sequence and 66.1~90.5% identity in amino acid sequence with 33 reference strains except for Boryong and Kuroki. JJ1 and JJ2 had 100 and 99.9% nucleotide identity to Boryong strain, and 99.9 and 99.8% to Kuroki, which has been known to be similar to Boryong, respectively. In addition, they showed 77.9~ 81.4% nucleotide identity with the cluster of Gilliam-related genotypes, whereas they showed higher nucleotide identity (89.6~90.8%) with the cluster of Karp-related genotypes. To our knowledge, this is the first report to isolate O. tsutsugamushi and characterize their genotype as the Boryong in Jinju and West Gyeongsangnam-do, Korea, even though it has been reported that the Boryong was the predominant genotype in isolates from chiggers, domestic rodents, and patients in the southern part of Korea. Furthermore, our isolates could be useful source to study on the pathophysiology and epidemiology of scrub typhus in Korea.
Amino Acid Sequence ; Base Sequence ; Chungcheongnam-do ; Epidemiology ; Genotype ; Gyeongsangnam-do* ; Humans ; Incidence ; Korea* ; Membrane Proteins ; Orientia tsutsugamushi* ; Rodentia ; Scrub Typhus* ; Trombiculidae

OBJECTIVE: This study aimed to examine clinical practice patterns in the management of pregnant women admitted with threatened preterm labor (TPL) in Korea. METHODS: Data from women admitted with a diagnosis of TPL were collected from 22 hospitals. TPL was defined as regular uterine contractions with or without other symptoms such as pelvic pressure, backache, increased vaginal discharge, menstrual-like cramps, bleeding/show and cervical changes. Data on general patient information, clinical characteristics at admission, use of tocolytics, antibiotics, and corticosteroids, and pregnancy outcomes were collected using an online data collections system. RESULTS: A total of 947 women with TPL were enrolled. First-line tocolysis was administered to 822 (86.8%) patients. As a first-line tocolysis, beta-agonists were used most frequently (510/822, 62.0%), followed by magnesium sulfate (183/822, 22.3%), calcium channel blockers (91/822, 11.1%), and atosiban (38/822, 4.6%). Of the 822 women with first-line tocolysis, second-line tocolysis were required in 364 (44.3%). Of 364 with second-line, 199 had third-line tocolysis (37.4%). Antibiotics were administered to 29.9% of patients (284/947) with single (215, 22.7%), dual (26, 2.7%), and triple combinations (43, 4.5%). Corticosteroids were administered to 420 (44.4%) patients. Betamethasone was administered to 298 patients (71.0%), and dexamethasone was administered to 122 patients (29.0%). CONCLUSION: Practice patterns in the management of TPL in Korea were quite various. It is needed to develop standardized practice guidelines for TPL management.
Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Back Pain ; Betamethasone ; Calcium Channel Blockers ; Dexamethasone ; Diagnosis ; Female ; Humans ; Korea ; Magnesium Sulfate ; Muscle Cramp ; Obstetric Labor, Premature* ; Physician's Practice Patterns ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Premature Birth ; Retrospective Studies* ; Tocolysis ; Tocolytic Agents ; Uterine Contraction ; Vaginal Discharge

In 1991, Kounis and Zavras described the "syndrome of allergic angina" as the coincidental occurrence of angina and allergic reactions by inflammatory mediators released during the allergic insult. Presently, both allergic angina and allergic myocardial infarction are referred to as "Kounis syndrome." Several allergens, including drugs, Hymenoptera venom, latex, food, and contrast media have been reported to trigger Kounis syndrome. Three variants of this syndrome have been described. Type I includes patients with normal coronary arteries, Type II includes patients with preexisting atheromatous disease where acute release of inflammatory mediators can induce coronary artery spasms, and Type III is associated with intracoronary thrombus formation caused by an allergic reaction. We report a case of Kounis syndrome who presented as acute myocardial infarction after intramuscular injection of a non-steroidal anti-inflammatory drug.
Allergens ; Anaphylaxis ; Contrast Media ; Coronary Vessels ; Humans ; Hymenoptera ; Hypersensitivity ; Injections, Intramuscular ; Latex ; Myocardial Infarction ; Spasm ; Thrombosis ; Venoms

BACKGROUND/AIMS: Acute pyelonephritis is relatively common in women. It has been well studied in young adults, but rarely in geriatric patients. Given that the population of Korea is aging rapidly, this study examined the clinical characteristics of acute pyelonephritis in Korean geriatric patients. METHODS: We retrospectively studied 499 patients diagnosed with acute community-acquired pyelonephritis from March 2002 to February 2005. All patients admitted to Hallym University Kangnam Sacred Heart Hospital from the emergency room or out-patient department were recruited. Pregnant women and hospital-acquired cases were excluded. RESULTS: Ninety-nine subjects (19.8%) were aged 65 years or over (mean age 73.1 +/- 6.3 years, range 65-93). Elderly patients had a greater male predominance, longer hospital stay, and higher rate of positive urine cultures than patients younger than 65 years. The presence of diabetes mellitus, complicated acute pyelonephritis, and a higher serum creatinine level were associated with geriatric patients. The distribution of infectious microorganisms was similar between the two groups. Old age (> 65 years) was an important risk factor for a long hospital stay, along with male gender, renal dysfunction, white blood count (WBC) and high serum alkaline phosphatase levels. CONCLUSIONS: Geriatric patients with acute pyelonephritis tended to be male, and have diabetes mellitus, renal dysfunction, complicated infections, and a longer duration of hospitalization.
Aged ; Aging ; Alkaline Phosphatase ; Creatinine ; Diabetes Mellitus ; Emergencies ; Female ; Geriatrics ; Heart ; Hospitalization ; Humans ; Korea ; Length of Stay ; Male ; Outpatients ; Pregnant Women ; Pyelonephritis ; Retrospective Studies ; Risk Factors ; Young Adult

Clostridium difficile (C. difficile) infection appears to be closely related to reactivation, diagnostic delay, and disease progression in patients with inflammatory bowel disease. However, whether C. difficile infection triggers the reactivation of inflammatory bowel disease or vice versa is not certain. We report a case of reactivated and progressed left ulcerative colitis following C. difficile infection in a 56-year-old woman. A series of endoscopic findings in this case report strongly supports a causative role of C. difficile infection on the reactivation and progression of ulcerative colitis.

Cyclosporine is an immunosuppressive agent that plays an important therapeutic role for organ transplantation. However, complications due to type 1 renal tubular acidosis, albeit rare, have been reported. We experienced a case of severe metabolic acidosis associated with cyclosporine administration after renal transplantation. A 54-year old man was hospitalized for seizure, confusion and weakness. He demonstrated severe metabolic acidosis and hypokalemia. Continuous renal replacement therapy was started and sodium bicarbonate was administered to correct the acidosis and the dosage of cyclosporine was reduced. Thereafter, the cyclosporine level in whole blood decreased gradually, and the metabolic acidosis improved.
Acidosis ; Acidosis, Renal Tubular ; Cyclosporine ; Hypokalemia ; Kidney ; Kidney Transplantation ; Organ Transplantation ; Renal Replacement Therapy ; Seizures ; Sodium Bicarbonate ; Transplants

Acute human immunodeficiency virus (HIV) syndrome is defined as transient symptomatic illness associated with high-titer HIV replication and an expansive immunologic response to the invading pathogen. Seizure and epilepsy are not rare among the HIV-infected patients. Major causes of HIV-related seizure are focal brain lesion, meningitis, metabolic derangement, and no identified causes other than HIV itself. Generally, seizure in HIV infected patients develops during the advanced stages of the disease; decreased immunity and increased chances of developing opportunistic infection in the central nervous system (CNS) predispose them to have seizures attacks. We report a case of acute HIV syndrome which presented as new-onset seizure. Since no evidence of focal brain lesion or any opportunistic infection could be found, the most probable cause of seizure could be attributed to acute HIV syndrome. The patient got better after taking anti-epileptic drug and there have been no further recurrence of episodes so far.
Brain ; Central Nervous System ; Epilepsy ; HIV ; Humans ; Meningitis ; Opportunistic Infections ; Recurrence ; Seizures

OBJECTIVE: Ghrelin is a newly isolated peptide from the stomach. Subsequent studies revealed that ghrelin is expressed in human placenta. Circulating ghrelin levels reflect acute and chronic energy balance in humans. However, it is not proven whether ghrelin plays a role during pregnancy. The purpose of this study was to compare relationship between ghrelin levels of maternal serum, umbilical vein and birth weight. METHODS: We measured maternal ghrelin levels (N=41) in each trimester and postpartum whose fetus were appropriate-for-gestational age. Also we checked cord blood ghrelin levels at delivery in appropriate-for-gestational age group (N=20) and small-for-gestational age group (N=20). RESULTS: Ghrelin was detected in all samples from maternal and cord blood. Maternal serum ghrelin levels showed a peak in the 2nd trimester (35.7+/-12.7 pg/mL) and decreased in the late 3rd trimester (26.5+/-10.3 pg/mL). An increase was observed again in postpartum, which was measured at one day after delivery. There was no significant correlation between maternal serum ghrelin level and birth weight (P>0.05), but there was statistically significant correlation between cord blood ghrelin level and birth weight (r=-0.411, P<0.05). CONCLUSION: Maternal serum ghrelin levels showed a peak around mid-gestation during pregnancy and then, decreased in the 3rd trimester, the time of increased maternal body weight. There was no association between maternal serum ghrelin level and birth weight. But small-for-gestational age neonates present with higher umbilical cord ghrelin level than that of appropriate-for-gestational age neonates. It is conceivable that ghrelin may play a physiologic role in fetal adaptation to intrauterine malnutritional state.
Birth Weight ; Body Weight ; Fetal Blood ; Fetus ; Ghrelin ; Humans ; Infant, Newborn ; Parturition ; Placenta ; Postpartum Period ; Pregnancy ; Stomach ; Umbilical Cord ; Umbilical Veins

Triple valve surgery is usually complex and carries a reported operative mortality of 13% and 10-yr survival of 61%. We examined surgical results based on our hospital's experience. A total of 160 consecutive patients underwent triple valve surgery from 1990 to 2006. The most common aortic and mitral valve disease was rheumatic disease (82%). The most common tricuspid valve disease was functional regurgitation (80%). Seventy-four percent of the patients were in New York Heart Association (NYHA) class III and IV. Univariate and multivariable analyses were performed to identify predictors of early and late survival. Operative mortality was 6.9% (n=11). Univariate factors associated with mortality included old age, preoperative renal failure, postoperative renal failure, pulmonary complications, and stroke. Of them, postoperative renal failure and stroke were associated with mortality on multivariable analysis. Otherwise, neither tricuspid valve replacement nor reoperation were statistically associated with late mortality. Survival at 5 and 10 yr was 87% and 84%, respectively. Ninety-two percent of the patients were in NYHA class I and II at their most recent follow-up. Ten-year freedom from prosthetic valve endocarditis was 97%; from anticoagulation-related hemorrhage, 82%; from thromboembolism, 89%; and from reoperation, 84%. Postoperative renal failure and stroke were significantly related with operative mortality. Triple valve surgery, regardless of reoperation and tricuspid valve replacement, results in acceptable long-term survival.
Adult ; Aged ; Anticoagulants/adverse effects/therapeutic use ; Aortic Valve/*surgery ; Female ; Heart Valve Diseases/complications/mortality/*surgery ; Heart Valve Prosthesis Implantation/*methods ; Hemorrhage/chemically induced/epidemiology ; Humans ; Intraoperative Complications/mortality ; Kidney Failure/etiology ; Male ; Middle Aged ; Mitral Valve/*surgery ; Postoperative Complications/mortality ; Reoperation ; Risk Factors ; Severity of Illness Index ; Stroke/etiology ; Survival Analysis ; Thromboembolism/epidemiology ; Tricuspid Valve/*surgery