Background/Aims: There is a recent increase in the use of stool multiplex PCR assay-based diagnostic tests in patients with acute diarrhea. We used multiplex PCR assays to analyze the distribution of diarrhea-causing bacteria and viruses, as well as the clinical features of patients with acute diarrhea. Methods: We retrospectively reviewed stool specimens of inpatients complaining of acute diarrhea from October 2018 to July 2020.The stool specimens had been tested for bacteria and viruses using multiplex PCR assays. Results: A total of 414 stool specimens from 346 patients were tested, and 152 pathogens were detected in 131 stool samples (131/414, 31.6%). Co-infection was detected in 20 patients (20/346, 5.8%). The common pathogens detected as causes of acute diarrhea, including co-infection, were Clostridium perfringens (34.9%), Clostridioides difficile (19.7%), and Campylobacter spp. (18.4%). The average age of patients with multiplex PCR-positive tests was lower than those with multiplex PCR-negative tests (p=0.001). In patients with suspected C. difficile infection (CDI), the RT-PCR for toxin gene assay was performed in 370 stool samples, 35 of which were positive (9.5%). Furthermore, 16 of the 35 samples were positive on the multiplex PCR assay (45.7%). Conclusions The multiplex PCR assay revealed that C. perfringens was the most common diarrhea-causing pathogen. In addition, in patients with suspected CDI, the multiplex PCR assay alone was insufficiently sensitive to detect pathogens and a conventional CDI test was additionally required.

Recent evidence has suggested that human skin fibroblasts may represent a novel source of therapeutic stem cells. In this study, we report a 3-stage method to induce the differentiation of skin fibroblasts into insulin-producing cells (IPCs). In stage 1, we establish the isolation, expansion and characterization of mesenchymal stem cells from human labia minora dermis-derived fibroblasts (hLMDFs) (stage 1: MSC expansion). hLMDFs express the typical mesenchymal stem cell marker proteins and can differentiate into adipocytes, osteoblasts, chondrocytes or muscle cells. In stage 2, DMEM/F12 serum-free medium with ITS mix (insulin, transferrin, and selenite) is used to induce differentiation of hLMDFs into endoderm-like cells, as determined by the expression of the endoderm markers Sox17, Foxa2, and PDX1 (stage 2: mesenchymal-endoderm transition). In stage 3, cells in the mesenchymal-endoderm transition stage are treated with nicotinamide in order to further differentiate into self-assembled, 3-dimensional islet cell-like clusters that express multiple genes related to pancreatic beta-cell development and function (stage 3: IPC). We also found that the transplantation of IPCs can normalize blood glucose levels and rescue glucose homeostasis in streptozotocin-induced diabetic mice. These results indicate that hLMDFs have the capacity to differentiate into functionally competent IPCs and represent a potential cell-based treatment for diabetes mellitus.
Animals ; Biological Markers/metabolism ; *Cell Culture Techniques ; *Cell Differentiation ; Cell Proliferation/drug effects ; Cell Separation ; Cells, Cultured ; Dermis/*cytology/drug effects ; Diabetes Mellitus, Experimental/*surgery ; Female ; Fibroblasts/*cytology/drug effects ; Genitalia, Female/*cytology ; Glucose/metabolism ; Hepatocyte Nuclear Factor 3-beta/metabolism ; Homeodomain Proteins/metabolism ; Humans ; Insulin/pharmacology/secretion ; Insulin-Secreting Cells/*cytology/metabolism ; *Islets of Langerhans Transplantation ; Mesenchymal Stem Cells/*cytology/drug effects/metabolism ; Mice ; Mice, Nude ; Niacinamide/pharmacology ; Recovery of Function ; SOXF Transcription Factors/metabolism ; Sodium Selenite/pharmacology ; Trans-Activators/metabolism ; Transferrin/pharmacology

OBJECTIVE: Thoracoscopic spinal surgery provides minimally invasive approaches for effective vertebral decompression and reconstruction of the thoracic and thoracolumbar spine, while surgery related morbidity can be significantly lowered. This study analyzes clinical results of thoracoscopic spinal surgery performed at our institute. METHODS: Twenty consecutive patients underwent video-assisted thoracosopic surgery (VATS) to treat various thoracic and thoracolumbar pathologies from April 2000 to July 2006. The lesions consisted of spinal trauma (13 cases), thoracic disc herniation (4 cases), tuberculous spondylitis (1 case), post-operative thoracolumbar kyphosis (1 case) and thoracic tumor (1 case). The level of operation included upper thoracic lesions (3 cases), midthoracic lesions (6 cases) and thoracolumbar lesions (11 cases). We classified the procedure into three groups: stand-alone thoracoscopic discectomy (3 cases), thoracoscopic fusion (11 cases) and video assisted mini-thoracotomy (6 cases). RESULTS: Analysis on the Frankel performance scale in spinal trauma patients (13 cases), showed a total of 7 patients who had neurological impairment preoperatively : Grade D (2 cases), Grade C (2 cases), Grade B (1 case), and Grade A (2 cases). Four patients were neurologically improved postoperatively, two patients were improved from C to E, one improved from grade D to E and one improved from grade B to grade D. The preoperative Cobb's and kyphotic angle were measured in spinal trauma patients and were 18.9+/-4.4 degrees and 18.8+/-4.6 degrees, respectively. Postoperatively, the angles showed statistically significant improvement, 15.1+/-3.7 degrees and 11.3+/-2.4 degrees, respectively (P<0.001). CONCLUSION: Although VATS requires a steep learning curve, it is an effective and minimally invasive procedure which provides biomechanical stability in terms of anterior column decompression and reconstruction for anterior load bearing, and preservation of intercostal muscles and diaphragm.
Decompression ; Diaphragm ; Diskectomy ; Humans ; Intercostal Muscles ; Kyphosis ; Learning Curve ; Pathology* ; Spinal Fractures ; Spinal Fusion ; Spine ; Spondylitis ; Thoracic Surgery, Video-Assisted ; Weight-Bearing

PURPOSE: To assess the therapeutic effect of Novalis radiosurgery for metastatic spinal tumors and evaluate the changes after treatment using MR imaging. MATERIALS AND METHODS: Between November 2003 and June 2005, 21 patients with metastatic spinal tumors underwent Novalis radiosurgery. Of these patients, the 7 with 13 metastatic spinal tumors who had undergone follow-up MR imaging were included in this study. The tumor locations were cervical spine in three, thoracic spine in four, lumbar spine in five and sacrum in one. During the first three months after Novalis radiosurgery, follow-up MRI was performed monthly and subsequently at 3-6-month intervals. On MR imaging, the volume of the tumors, the changes of their signal intensities and any changes in adjacent spinal cord were evaluated. RESULTS: Among the 13 lesions, 9 were decreased in volume (69.2%), 2 were stable (15.4%) and 2 were slightly increased. Seven of 9 lesions showed decreased signal intensity on T2 weighted images and 4 had compressive deformity. Two of 9 lesions had increased T2 signal intensity and tumor necrosis were detected on contrast-enhanced MR imaging. No changes in spinal cord were noted in any of the lesions. Those changes were detected on MRI obtained 1 month after Novalis surgery and the lesion sizes were gradually changed up to 3 months. CONCLUSION: Novalis radiosurgery was effective for the treatment of metastatic spinal tumor and the suppression of tumor growth. The estimation of therapeutic effect and detecting complication were precisely evaluated on MR imaging.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Necrosis ; Radiation Oncology ; Radiosurgery* ; Sacrum ; Spinal Cord ; Spine

OBJECTIVE: Middle cerebral artery (MCA) aneurysm, which takes up about 25% of all intracranial aneurysms, usually occurs in MCA bifurcation, and 10% occurs in proximal MCA, and about 1% occurs in distal MCA. For that reason, it is rare to find an understanding and report on distal MCA aneurysm in its clinical aspect and radiological characteristics. In this class, four people experienced distal MCA aneurysm with subarachnoid hemorrhage (SAH), and it was reported along with document research. METHODS: Among the 214 intracranial aneurysm operations carried out in this class from May 2001 to May 2004, We report four ruptured distal MCA aneurysms. RESULTS: Distal MCA aneurysm was equal male to female ratio, and manifested in M2 segment mainly. In the case of ruptured distal MCA aneurysm, intracerebral hematoma (ICH) is usually accompanied, showing poor pre-operation grade, and no intracranial aneurysm was found on other regions. Except one case of mycotic aneurysm, all were saccular types. Aneurysm clipping was carried out in trans-sylvian approach, and except one case of Glasgow Coma Scale (GCS) of 3 points before operation, all showed good recovery. CONCLUSION: Distal MCA aneurysm is usually accompanied by ICH and shows poor preoperative grade, but early surgery draws favorable outcome. Distal aneurysm is not anatomically well known and has problems in dissection, therefore intraoperative angiography can be helpful to the surgery, and in case distal MCA aneurysm should be discovered, it is wise to carry out an evaluation on the possibility of mycotic aneurysm.
Aneurysm ; Aneurysm, Infected ; Angiography ; Female ; Glasgow Coma Scale ; Hematoma ; Humans ; Intracranial Aneurysm* ; Male ; Middle Cerebral Artery* ; Subarachnoid Hemorrhage

OBJECTIVE: To evaluate the clinical outcome and characteristics of laparoscopy assisted vaginal hysterectomy (LAVH) in gynecologic patients. METHODS: From September, 2001 to February, 2004, total 570 cases of patients were performed LAVH at Gacheon medical school Ghil Hospital. We reviewed medical records and analyzed these cases about age, parity, weight, previous surgery history, operation indication, operation outcome, duration of hospitalization and complication. RESULTS: The results of this study summarized as follows. The mean age of patients was 46.4 +/- 7.2 years old. Average parity of patients was 2.4 +/- 1.4. Average weight of patients was 63.4 +/- 8.2 kg. Previous operation history was 195 cases (34.2%). Most common operation indication was uterine leiomyoma, followed by adenomyosis, combination of leiomyoma and adenomyosis and endometriosis. The mean operation time was 72 +/- 20.6 minutes. The mean duration of hospitalization was 4.5 +/- 0.6 days. The major complication of operation was trocar site bleeding, followed by bladder injury, bowel injury, and ureteral injury. CONCLUSION: LAVH is safe and useful. So it is recommendable to gynecologic patients.
Adenomyosis ; Endometriosis ; Female ; Hemorrhage ; Hospitalization ; Humans ; Hysterectomy, Vaginal* ; Laparoscopy* ; Leiomyoma ; Medical Records ; Parity ; Schools, Medical ; Surgical Instruments ; Ureter ; Urinary Bladder

OBJECTIVE: To analyze cytogenetic results of prenatal genetic amniocentesis. METHODS: From January 1997 to December 2000, We analyzed 1,390 cases of midtrimester amniocentesis which were done at Gil medical center of Gachon medical school according to its indications and maternal age. RESULTS: Chromosomal aberrations were found in 88 cases (6.3%). Of all our chromosomal aberrations, 29 cases (2.1%) of normal variants and 59 cases (4.2%) of abnormal karyotypes were found. 37 cases of autosomal numerical abnormal karyotypes and 7 cases of sex chromosomal abnormal karyotypes were diagnosed. In abnormal karyotype group, the incidence was high after 40 years of maternal age and in abnormal ultrasound findings, but no such correlations were found in normal variant group. CONCLUSION: In analysis of midtrimester amniocentesis, it would be better to analyze separately abnormal karyotype group and normal variant group.
Abnormal Karyotype ; Amniocentesis ; Amniotic Fluid* ; Chromosome Aberrations* ; Cytogenetics* ; Female ; Humans ; Incidence ; Maternal Age ; Pregnancy ; Pregnancy Trimester, Second* ; Schools, Medical ; Ultrasonography

OBJECTIVE: The aim of this study was to evaluate the peripartum efficiency of amnioinfusion in oligohydramnios without preterm premature rupture of membrane. METHODS: 73 singleton pregnant women with oligohydramnios were enrolled in this study. Women with preterm premature rupture of membrane were excluded. 21 women were treated with transabdominal amnioinfusion 31 times and 52 women were closely observed without amnioinfusion. Mean amniotic fluid index, mean gestational age, mean maternal age and the parity at the time of diagnosis was not statistically different in both groups. RESULTS: Mean amounts of infused artificial amniotic fluid was 536ml (200-700), the mean time consumed was 61(+/-39.2)min. After infusion, mean amniotic fluid index was increased significantly from 4.2(+/-1.6) to 10.0(+/-2.9). But we found no statistically significant differences in pregnancy outcomes. The outcomes are as follows 1)Mean gestational age at birth was 36.3(+/-3.5) weeks in amnioinfusion group and 37.2(+/-2.9) weeks in control group. 2) Mean birth weight was 2.54(+/-0.9)kg versus 2.51(+/-0.8)kg. 3) The proportions of poor Apgar score at 1 minute and 5 minute were not significantly different. 4) Cesarean section rate was 0.79 versus 0.65. 5.There were two still births in both groups. CONCLUSION: Transabdominal amnioinfusion in oligohydramnios has little effects in improving longterm pregnancy outcomes.
Amniotic Fluid ; Apgar Score ; Birth Weight ; Cesarean Section ; Diagnosis ; Female ; Gestational Age ; Humans ; Maternal Age ; Membranes* ; Oligohydramnios* ; Parity ; Parturition ; Peripartum Period* ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Prognosis* ; Rupture*

PURPOSE: Children with developmental language disorder occupy considerable health care resources, particularly in the preschool ages. The exact size of problem for health planning remains somewhat problematic, as differences in reported estimates of prevalencies reflect the range of definitions used. In this study, we evaluated the clinical features of children with developmental language disorder and examined effctiveness of the Gesell Screening Inventory and REEL scale to assess language development. METHODS: The 171 children were involved in the study, they were referred to Child Development Clinic in Kangnam St. Mary's Hospital for evaluation of suspected language problem. Among the children, 75 cases between 15 and 54 months of age were included as developmental language disorder in this study. RESULTS: 1) The mean age of subjects was 31.4 months and the ratio of male to female was 6.5:1. 2) The mean gestational age of the subjects was 38.8 weeks. The proportion of full-term infants was 82.7% and the one of premature infants was 17.3%. 3) According to the birth ordering history, the proportion of the first baby was 82.7%, the one of second baby was 13.3% and the one of third baby was 4%. 4) Ten children had been checked up the MRI, four of them had abnormal findings, 23 children had been checked up the EEG and two of them showed abnormal findings. 5) The mean age of first spontaneous word with used meaning was 13.8 months. 6) According to the Gesell Screening Inventory, the proportion of children who had less than DQ 70 had showed 4% in motor sector, 17% in adaptive sector, 66.7% in laguage sector and 33.3% in personal social sector. 7) According to the REEL Scale, the proportion of children who had less DQ 70 had showed 70.7% of in receptive language sector and 90.7% in expressive language sector. 8) The proportion of the children who had been maintaining language disorder was 17.3% and that of those who showed normal linguistic development was 82.7% on the follow-up test 6 months later. CONCLUSION: The large proportion of the children who had language delay was developmental language disorder without organic problem. Most of them showed symptom improvement on the follow up test 6 months later.
Child Development ; Child* ; Delivery of Health Care ; Electroencephalography ; Female ; Follow-Up Studies ; Gestational Age ; Health Planning ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Language Development ; Language Development Disorders* ; Language Disorders ; Linguistics ; Magnetic Resonance Imaging ; Male ; Mass Screening ; Parturition

Intravenous immunoglobulin (IVIG) therapy is associated with a number of complications, including rare acute renal failure (ARF). Although the cause of IVIG-associated ARF is unknown, it may be related to the stabilizing agent used in IVIG preparations. ARF following IVIG infusion has not been previously described in children. We report a 4-year-old girl with Kawasaki disease who suffered from ARF following IVIG containing maltose. The previously healthy child had no underlying renal disease. She was given a 2g/kg body weight of IVIG (I.V.-Globulin S, Green Cross, IgG:maltose=1:2) for 10 hours. From the second day of IVIG administration, a gradual reduction of daily urine output was observed with an increase of BUN and creatinine levels, which by the fourth day of treatment reached 43.8mg/dL and 4.7mg/dL, respectively. A conservative ARF treatment resulted in a gradual increase in urine output, together with a decrease in BUN and creatinine levels, which after 7 days returned to normal levels. In view of the increasing use of IVIG in medicine, it is imperative that clinicians be aware of this unusual form of renal injury.
Acute Kidney Injury* ; Body Weight ; Child* ; Child, Preschool ; Creatinine ; Female ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Maltose ; Mucocutaneous Lymph Node Syndrome