Influenza vaccine-associated anaphylaxis is a very rare allergic reaction to vaccines, but the most concerning and life-threatening adverse reaction. Although the safety of influenza vaccines has been well documented, occasional cases of anaphylaxis in vaccinated patients have been reported. In this study, we analyzed the immunoglobulin E (IgE) response to whole influenza vaccines in a pediatric case of delayed-onset anaphylaxis after influenza vaccination. The patient showed elevated specific IgE levels against whole influenza vaccines, especially with split virion from egg-based manufacturing process. Specific IgE levels to influenza vaccines showed decreased over. We evaluated a causal relationship between influenza vaccine and anaphylaxis event by enzyme-linked immunosorbent assay. Delayed-onset anaphylaxis after influenza vaccination can occur in children without predisposing allergic diseases. In addition, the results suggested that formulation and production system of influenza vaccines could affect the probability of severe allergic reaction to vaccines.
Anaphylaxis ; Child ; Drug Hypersensitivity ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Immunoglobulin E ; Immunoglobulins ; Influenza Vaccines ; Influenza, Human ; Vaccination ; Vaccines ; Virion

PURPOSE: Enzyme-linked immunosorbent assay (ELISA) has been used in the diverse field to evaluate influenza virus infection; for the surveillance, diagnosis, efficacy evaluation, and development of the vaccine. The aim of this study was to establish an ELISA for detecting HA strain-specific antibodies using recombinant pandemic A H1N1 (pH1N1) HA1 (rHA1) protein. MATERIALS AND METHODS: rHA1 was produced in baculovirus system. The clinical performance of the developed ELISA was validated using human serum samples, by comparison with standard methods for detecting a neutralizing antibody; hemagglutination inhibition (HI) assay and microneutralization test (MNT). The ability of the ELISA system to evaluate the efficacy test of an influenza vaccine was explored by measuring antibody levels in the serum of vaccinated mice. RESULTS: Our ELISA could detect anti-rHA1 antibody in influenza-infected patients and vaccinated subjects. Compared to HI assay and MNT as reference methods, our method showed good performance in detection of anti-rHA1 antibody. Detection of the anti-rHA1 antibody in vaccinated mice and its correlation with titers in HI assay was also proved in a mice model. CONCLUSION: An ELISA system using rHA1 of pH1N1 influenza virus was developed, and showed good clinical performance in diagnosis of influenza virus infection and evaluation of the vaccination efficacy in both human and animal models.
Animals ; Antibodies ; Antibodies, Neutralizing ; Baculoviridae ; Diagnosis ; Enzyme-Linked Immunosorbent Assay* ; Hemagglutination ; Humans ; Influenza A virus ; Influenza Vaccines ; Influenza, Human* ; Methods ; Mice ; Models, Animal ; Orthomyxoviridae* ; Pandemics* ; Vaccination

PURPOSE: Fibroblast growth factor 21 (FGF21) is a crucial metabolic regulator, with multiple favorable effects on glucose homeostasis and lipid metabolism. Since serum FGF21 level has been implicated as a potential marker for the early identification of metabolic syndrome (MetS), we investigated the association between serum FGF21 level and the development of MetS in a population-based prospective study. MATERIALS AND METHODS: We conducted a prospective study of 221 randomly sampled adults without MetS from a general population-based cohort study who were examined from 2005–2008 (baseline) and from 2008–2011 (follow-up). Baseline serum FGF21 levels were analyzed using enzyme-linked immunosorbent assay. RESULTS: During the average 2.8-year follow-up period, 82 participants (36.6%) developed new-onset MetS. Serum FGF21 levels were significantly higher in patients with new-onset MetS than in those without MetS (209.56±226.80 vs. 110.09±81.10, p < 0.01). In multivariate adjusted models, the odds for MetS development were greater in patients with serum FGF21 levels in the highest quartile, compared to those in the lowest quartile (3.84, 95% confidence interval: 1.59–9.28). CONCLUSION: Serum FGF21 level was an independent predictor for new-onset MetS in a population-based prospective study.
Biomarkers/blood ; Female ; Fibroblast Growth Factors/*blood ; Humans ; Male ; Metabolic Syndrome/*blood ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Prospective Studies

PURPOSE: The purpose of this study was to evaluate the benefits of adjuvant treatment for curatively resected thoracic esophageal squamous cell carcinoma (ESCC) and determine the optimal adjuvant treatments. MATERIALS AND METHODS: One hundred ninety-five patients who underwent a curative resection for thoracic ESCC between 1994 and 2014 were reviewed retrospectively. Postoperatively, the patients received no adjuvant treatment (no-adjuvant group, n=68), adjuvant chemotherapy (AC group, n=62), radiotherapy (RT group, n=41), or chemoradiotherapy (CRT group, n=24). Chemotherapy comprised cisplatin and 5-fluorouracil administration every 3 weeks. The median RT dose was 45.0 Gy (range, 34.8 to 59.4 Gy). The overall survival (OS), disease-free survival (DFS), locoregional recurrence (LRR), and distant metastasis (DM) rates were estimated. RESULTS: At a median follow-up duration of 42.2 months (range, 6.3 to 215.2 months), the 5-year OS and DFS were 37.6% and 31.4%, respectively. After adjusting for other clinicopathologic variables, the AC and CRT groups had a significantly better OS and DFS compared to the no-adjuvant group (p < 0.05). The LRR rate was significantly lower in the RT and CRT groups than in the no-adjuvant group (p < 0.05), whereas no significant difference was observed in the AC group. In the no-adjuvant and AC groups, 25% of patients received high-dose salvage RT due to LRR. The DM rates were similar. The anastomotic stenosis and leakage were similar in the treatment groups. CONCLUSION: Adjuvant treatment might prolong survival after an ESCC resection, and RT contributes to a reduction of the LRR. Overall, the risks and benefits should be weighed properly when selecting the optimal adjuvant treatment.
Carcinoma, Squamous Cell* ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Cisplatin ; Constriction, Pathologic ; Disease-Free Survival ; Drug Therapy ; Epithelial Cells* ; Esophageal Neoplasms ; Fluorouracil ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Risk Assessment

The pneumonia severity index (PSI) and CURB-65 are widely used tools for the prediction of community-acquired pneumonia (CAP). This study was conducted to evaluate validation of severity scoring system including the PSI and CURB-65 scores of Korean CAP patients. In the prospective CAP cohort (participated in by 14 hospitals in Korea from January 2009 to September 2011), 883 patients aged over 18 yr were studied. The 30-day mortalities of all patients were calculated with their PSI index classes and CURB scores. The overall mortality rate was 4.5% (40/883). The mortality rates per CURB-65 score were as follows: score 0, 2.3% (6/260); score 1, 4.0% (12/300); score 2, 6.0% (13/216); score 3, 5.7% (5/88); score 4, 23.5% (4/17); and score 5, 0% (0/2). Mortality rate with PSI risk class were as follows: I, 2.3% (4/174); II, 2.7% (5/182); III, 2.3% (5/213); IV, 4.5% (11/245); and V, 21.7% (15/69). The subgroup mortality rate of Korean CAP patients varies based on the severity scores and CURB-65 is more valid for the lower scores, and PSI, for the higher scores. Thus, these variations must be considered when using PSI and CURB-65 for CAP in Korean patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Cohort Studies ; Community-Acquired Infections/*mortality ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pneumonia/*mortality ; Prospective Studies ; Republic of Korea ; *Severity of Illness Index ; Young Adult

Ficus carica L. (fig) belongs to the mulberry tree (Moraceae) which is one of the oldest fruits in the world. It has been used as a digestion promoter and a cure for ulcerative inflammation and eruption in Korea. The present study investigated the antimicrobial activity of methanol (MeOH) extract of figs against oral bacteria. The MeOH extract (MICs, 0.156 to 5 mg/ml; MBCs, 0.313 to 5 mg/ml) showed a strong antibacterial activity against oral bacteria. The combination effects of MeOH extract with ampicillin or gentamicin were synergistic against oral bacteria. We suggest that figs could be employed as a natural antibacterial agent in oral care products.
Ampicillin ; Bacteria ; Carica ; Digestion ; Ficus ; Fruit ; Gentamicins ; Inflammation ; Korea ; Methanol ; Morus ; Trees ; Ulcer

PURPOSE: In spite of medical advances, empyema is a serious complication of pneumonia in children. Vaccination practices and antibiotic prescribing practices promote the change of clinical manifestations of empyema and causative organisms. So we made a nationwide clinical observation of 122 cases of empyema in children from 32 hospitals during the 5 year period from September 1999 to August 2004. METHODS: Demographic data, and clinical information on the course and management of empyema patients were collected retrospectively from medical records in secondary and tertiary hospitals in Korea. RESULTS: One hundred twenty two patients were enrolled from 35 hospitals. The most frequent age group was 1-3 years, accounting for 48 percent of all cases. The male to female sex ratio was 1.2:1. The main symptoms were cough, fever, respiratory difficulty, lethargy and chest pain in order of frequency. Hematologic findings on admission revealed decreased hemoglobin levels (10.4+/-1.6 g/dL) and increased leukocyte counts (16,234.3+/-10,601.8/microliter). Pleural fluid obtained from patients showed high leukocyte counts (30,365.8+/-64,073.0/microliter), high protein levels (522.3+/-1582.3 g/dL), and low glucose levels (88.1+/-523.5 mg/dL). Findings from pleural fluid cultures were positive in 80 cases(65.6 percent). The most common causative agent was Streptococcus pneumoniae. The majority of patients were treated with antibiotics and closed drainage. Some patients needed open drainage (16.4 percent) or decortication (3.3 percent). The mean duration of hospitalization was 28.6+/-15.3 days. CONCLUSION: We analyzed childhood empyema patients during a period of 5 years in Korean children. The most frequent age group was 1-3 years and the most common causative agent was Streptococcus pneumoniaeiae. The majority of patients were treated with antibiotics and close drainage.
Anti-Bacterial Agents ; Chest Pain ; Child ; Cough ; Drainage ; Empyema* ; Female ; Fever ; Glucose ; Hospitalization ; Humans ; Korea* ; Lethargy ; Leukocyte Count ; Male ; Medical Records ; Pneumonia ; Retrospective Studies ; Sex Ratio ; Streptococcus ; Streptococcus pneumoniae ; Tertiary Care Centers ; Vaccination

PURPOSE: Off-pump coronary artery bypass (OPCAB) is known to be associated with a lower risk of acute renal failure (ARF) than on-pump method. However, little data is available on ARF in OPCAB. The aim of the present study was to identify the incidence, risk factors, and mortality of ARF in OPCAB. METHODS: Perioperative variables in medical records of 573 patients who had undergone OPCAB from Jan 2000 to June 2004 were evaluated. ARF was defined as a 50% increase in preoperative serum creatinine (over 1.4 mg/dL) within 72 hours after operation, or as the need for postoperative dialysis. RESULTS: The incidence of ARF and ARF requiring dialysis were 9.8% and 2.6%, respectively. The independent risk factors for ARF after OPCAB were the perioperative use of an intra-aortic balloon pump (OR, 4.425; 95% CI, 2.342-8.403), high preoperative serum creatinine (OR 2.099; 95% CI, 1.422-3.098), diabetes (OR, 1.961; 95% CI, 1.078-3.571), and old age (OR, 1.479; 95% CI, 1.034- 2.116). The in-hospital mortality rate was 53.3% for patients requiring dialysis, 19.6% for all ARF patients and 0.8% for patients without ARF (p<0.001). The 3-year cumulative mortality rate was 38.4 % in all ARF patients and 5.2% in patients without ARF (p<0.001). CONCLUSION: ARF was not an uncommon complication in adults who underwent OPCAB. Perioperative hemodynamic instability, preoperative renal dysfunction, diabetes, and age could independently predict the development of ARF after OPCAB and the severity of ARF was related to higher in-hospital and long-term mortality rates.
Acute Kidney Injury* ; Adult ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Creatinine ; Dialysis ; Hemodynamics ; Hospital Mortality ; Humans ; Incidence* ; Medical Records ; Mortality ; Renal Insufficiency ; Risk Factors*

PURPOSE: Number of patients expecting for kidney transplantation and transplantations in foreign countries are rapidly increasing. However, there was a lack of information about clinical progresses and outcomes of kidney recipients, underwent cadaveric kidney transplantation in China. METHODS: We included 44 patients (China group), received cadaveric kidney transplantation in China and have been managed at our institute from Jan 2002 to Jan 2006 and 33 patients (domestic group), received cadaveric kidney transplantation at our institute from Feb 2000 to Jan 2006. We performed retrospective study based on medical records. RESULTS: Duration of pre-transplantation renal replacement therapy and of post-transplantation follow up was longer in domestic group (China group vs. domestic group; 89.9 months vs. 24.6 months, 31.9 months vs. 13.9 months) (p<0.05, p<0.05). Final GFR of China group was lower than domestic group (China group vs. domestic group; 54.97+/-18.92 mL/min vs. 64.26+/-18.23 mL/min) (p<0.05). Infection and rejection rates of China group were higher than domestic group (Incidences/ Pantients *Yr./1000; China group vs. domestic group; infection; 2.05 vs. 0.76, rejection; 1.34 vs. 0.51) (p<0.05). There was no difference of patient and graft survival between two groups. CONCLUSION: Korean recipients of Chinese cadaveric kidneys showed lower final GFR and higher rates of infection and rejection. We should be aware of the possible rejections and complications of kidney recipients undergoing cadaveric kidney transplantation in China. Mutual exchange of information about current status of patients, transplantation indications, donor status and treatment protocols is needed between foreign transplantation centers and our medical centers.
Asian Continental Ancestry Group ; Cadaver* ; China* ; Follow-Up Studies ; Graft Survival ; Humans ; Kidney Transplantation* ; Kidney* ; Medical Records ; Renal Replacement Therapy ; Retrospective Studies ; Tissue Donors

Acute humoral rejection after renal transplantation is associated with a higher frequency of allograft dysfunction and graft loss. We report a case of acute humoral rejection which was treated successfully with plasmapheresis and intravenous immunoglobulin. A 31- year-old man developed azotemia after kidney transplantation. Kidney biopsy finding was compatible with antibody-mediated rejection, demonstrated by the infiltration of monocytes and neutrophils and the deposition of C4d on glomerulus and peritubular capillaries. We performed five plasmapheresis with concomitant treatment of intravenous immunoglobulin after each session. With aggressive treatment, there was improvement of oliguric acute renal failure, accompanied by decrease in the percentage of PRA and the titer of donor specific antibodies. Repeated kidney biopsy revealed persistent C4d staining on peritubular capillaries despite disappearance of donor specific antibodies. In conclusion, plasmapheresis and intravenous immunoglobulin are effective in treating acute humoral rejection.
Male ; Humans ; Biopsy