Zika virus (ZIKV) is a mosquito-borne flavivirus associated with severe neurological disorders including Guillain-Barré syndrome and microcephaly. The host innate immune responses against ZIKV infection are essential for protection; however, ZIKV has evolved strategies to evade and antagonize antiviral responses via its nonstructural (NS) proteins. Here, we demonstrated that ZIKV infection unexpectedly inhibits NLRP3-dependent inflammasome activation in bone marrow-derived macrophages and mixed glial cells from mouse brain. ZIKV infection led to increased transcript levels of proinflammatory cytokines such as IL-1β and IL-6 via activating NF-κB signaling. However, ZIKV infection failed to trigger the secretion of active caspase-1 and IL-1β from macrophages and glial cells even in the presence of LPS priming or ATP costimulation. Intriguingly, ZIKV infection significantly attenuated NLRP3-dependent, but not absent in melanoma 2-dependent caspase-1 activation and IL-1β secretion from both cells. ZIKV infection further blocked apoptosis-associated speck-like protein containing a caspase recruitment domain oligomerization in LPS/ATP-stimulated macrophages. Interestingly, expression of ZIKV NS3 protein reduced NLRP3-mediated caspase-1 activation and IL-1β secretion in macrophages, whereas NS1 and NS5 proteins showed no effects. Furthermore, NLRP3 was found to be degraded by the overexpression of ZIKV NS3 in 293T cells. Collectively, these results indicate that ZIKV evades host NLRP3 inflammasome-mediated innate immune responses in macrophages and glial cells; this may facilitate ZIKV's ability to enhance the replication and dissemination in these cells.
Adenosine Triphosphate ; Animals ; Brain ; Caspase 1 ; Cytokines ; Flavivirus ; Guillain-Barre Syndrome ; HEK293 Cells ; Immunity, Innate ; Inflammasomes ; Interleukin-6 ; Macrophages ; Melanoma ; Mice ; Microcephaly ; Nervous System Diseases ; Neuroglia ; Zika Virus

PURPOSE: The aim of this study was to compare the drainage amount, total blood loss, and clinical results between two different positions of suction drainage after total knee arthroplasty. MATERIALS AND METHODS: A total of 100 patients who underwent one stage bilateral total knee arthroplasty were enrolled. In experiment 1 with 50 patients, we compared the drainage amount, pain, range of motion, and complications of the leg whose suction drain was inserted into the joint cavity with those of the contralateral leg whose suction drain was inserted in subcutaneous tissue. Another 50 patients of experiment 2 had suction drainage in the joint cavity of both legs and the total blood loss (sum of drainage output, exudates, and hematoma of subcutaneous tissue and joint) was calculated and compared with that of experiment 1. RESULTS: In experiment 1, the drainage amount was less in the leg with suction drainage in subcutaneous tissue compared with the contralateral leg with suction drainage in the joint cavity (p<0.001). However, the postoperative joint pain was significantly different only on post-operative day 2 between two legs. In experiment 2, there was no significant difference in the total blood loss between the two groups. CONCLUSION: Although the drainage amount was less in the leg whose suction drain was kept in subcutaneous tissue compared with the contralateral leg whose suction drain was in the joint cavity, the total blood loss and the clinical results were not significantly different according to the position of the suction drain. Therefore, we can conclude that the subcutaneous position of the suction drain did not yield superior results.
Arthralgia ; Arthroplasty* ; Drainage ; Exudates and Transudates ; Hematoma ; Humans ; Joints ; Knee* ; Leg ; Range of Motion, Articular ; Subcutaneous Tissue ; Suction*

BACKGROUND: The aim of our study was to evaluate the "diagnosis changed" rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). METHODS: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: "diagnosis maintained", "diagnosis changed" (initially notified as TB, but ultimately diagnosed as non-TB), and "administrative error" (notified as TB due to administrative errors). RESULTS: Excluding 17 patients in the "administrative error" group, the "diagnosis maintained" and "diagnosis changed" groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of "diagnosis changed" were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn's disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a "diagnosis changed" result via multivariate logistic regression analysis in pulmonary TB cases. CONCLUSION: Because of a high "diagnosis changed" rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the "diagnosis changed" rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of "diagnosis changed" cases is desirable.
Crohn Disease ; Diagnostic Errors ; Humans ; Incidence ; Korea ; Logistic Models ; Meningitis ; Nontuberculous Mycobacteria ; Pneumonia ; Tertiary Care Centers* ; Tuberculosis*

BACKGROUND: The isolation of non-tuberculous mycobacteria (NTM) has been increasing in South Korea. To date, however, the cause of this increase has not been determined, and it remains unclear whether the use of liquid media has contributed to this increase. The aim of this study was to evaluate the factors associated with NTM isolation and the impact of liquid media on NTM culture. METHODS: Mycobacterial smear/culture results of respiratory specimens (sputum and bronchial aspirates), obtained during the years 2002, 2005, and 2010, were retrieved and analyzed retrospectively. RESULTS: During the years 2002, 2005, and 2010, 83,096 sputum specimens were collected from 31,104 patients, and were cultured for mycobacteria, using solid media only in the 2002 and 2005 specimens and both solid and liquid media in the 2010. Of these, 3,516 (4.2%) specimens were smear-positive for acid-fast bacilli (AFB). The annual rate of NTM among positive culture specimens increased from 21% in 2002 to 57.8% in 2010 (p<0.001), as did the proportion of NTM, among AFB smear- and culture-positive specimens, from 12.2% in 2002 to 45.2% in 2010 (p<0.001). In 2010, the NTM culture rate was higher in the liquid than in the solid media (13.9% vs. 8.4%, p<0.001). The NTM rate among AFB-positive specimens was higher in patients aged >50 than < or =50 years. CONCLUSION: The rate of NTM isolation has steadily been increasing at the hospital in South Korea, likely due in part to the use of liquid media for the culture.
Aged ; Culture Media ; Humans ; Nontuberculous Mycobacteria ; Republic of Korea ; Sputum

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the relationship between myocardial strain and coronary flow reserve (CFR) in the prediction of myocardial functional recovery after acute myocardial infarction (AMI). SUBJECTS AND METHODS: Consecutive patients with anterior ST elevation AMI were analyzed. Left ventricular (LV) strain, determined by 2-dimensional speckle tracking imaging and CFR, determined by intracoronary flow measurement, were obtained on the same day, 3-5 days after primary percutaneous coronary intervention. A-strain was defined as the mean systolic longitudinal strain of 11 LV segments (out of 18) assumed to be supplied by the left anterior descending coronary artery (LAD). Functional recovery was defined as improved wall motion >1 grade seen in at least 2 contiguous dysfunctional segments by echocardiography at the 6-month follow-up. RESULTS: Of 20 patients, 8 patients had preserved CFR (>2.0) and 12 patients had impaired CFR (< or =2.0). There were no differences between the 2 CFR groups in LV ejection fractions and wall motion score indices in the LAD territory. However, A-strain was greater in patients with preserved CFR than in patients with impaired CFR (-6.4+/-2.0% vs. -4.6+/-1.4%, p=0.03). A-strain and CFR correlated well with each other (r=-0.49, p=0.03). Ten of 20 patients showed functional recovery at 6 months. Of clinical and echocardiographic parameters, A-strain was the only predictor of recovery (odds ratio 2.02, 95% confidence interval=1.03-3.97, p=0.04). For predicting recovery, the sensitivity and specificity were 80.0% and 80.0%, respectively, for CFR (cutoff=1.60), and 60.0% and 90.0%, respectively, for A-strain (cutoff=-6.13%). CONCLUSION: Myocardial strain correlates well with the extent of microvascular integrity and can be used as a noninvasive method for predicting recovery after AMI.
Coronary Vessels ; Echocardiography ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Sensitivity and Specificity ; Sprains and Strains ; Track and Field

To evaluate the prognostic importance of chromosomal instability (CIN) in squamous cell carcinoma (SCC) of the lung, the relationship between CIN detected by fluorescence in situ hybridization (FISH) and survival in SCC patients was examined. Forty-seven surgical specimens of lung SCC were analyzed. To identify tumors with CIN, p16 and multi-target DNA FISH assays for c-myc, chromosome 6, EGFR, and chromosome 5 (LAVysion, Vysis) were performed on nuclei extracted from paraffin-embedded tumor tissues. Survival rates were compared in terms of age, T factor, N factor, CIN, and smoking status. A sample was defined as CIN-positive if at least four of the five chromosomes were positive. Among the 47 specimens, 9 (19%) were CIN-positive. The overall survival rate was 66%. Overall survival rates were estimated as 33.3% for CIN-positive patients and 76.7% for CIN-negative patients (Hazard ratio 3.47; 95% Confidence interval, 1.25-9.67; P=0.017). In multivariate analysis, the presence of CIN was a predictive factor for survival. CIN-positive based on FISH can be prognostic factor of lung SCC.

Rupture of the sinus of Valsalva is an extremely rare complication after percutaneous coronary intervention (PCI). Because it usually results from the retrograde extension of a dissection of the right coronary artery and may quickly spread to involve the entire aorta, it can cause life-threatening complications such as aortic dissection. If the dissection remains localized, it can resolve spontaneously in the first month. Our patient experienced a delayed rupture of the right sinus of Valsalva into the right atrium at approximately 3 months after PCI.
Aged ; Angioplasty, Transluminal, Percutaneous Coronary/*adverse effects ; Aortic Rupture/*etiology ; Echocardiography, Transesophageal ; Heart Atria/*pathology ; Humans ; Male ; *Sinus of Valsalva ; Time Factors

BACKGROUND: The efficacy of several thrombolytic agents for treating massive pulmonary thromboembolism (PTE) has been reported to be similar. However, the difference of the bleeding complications caused by two commonly used thrombolytic agents in PTE patients is not well known. The aim of this study was to compare the therapeutic efficacy and the bleeding complications between urokinase and recombinant tissue-type plasminogen activatior(rt-PA, alteplase) in a Korean medical center. METHODS: We retrospectively reviewed the clinical data of the patients who were treated with thrombolytic agents(urokinase and alteplase) because of massive PTE. RESULTS: A total of 40 patients were included: 16 (40%) treated with urokinase and 24 (60%) with alteplase. The patients treated with alteplase showed a shorter duration of using vasopressor agents than did the patients who were given urokinase, but the duration of mechanical ventilation, the length of the ICU stay and the hospital stay were not different between the thrombolytic agents. Five patients treated with urokinase and eight patients treated with alteplase died (p=0.565): One patient in the urokinase group and four patients in the alteplase group died due to pulmonary thromboembolism. Bleeding complications after thrombolysis were observed in 3 patients(7.5%) treated with urokinase and in 11 (27.5%) patients treated with alteplase (p=0.079). Major bleeding complication occurred in 2 patients who were treated with alteplase. CONCLUSION: Urokinase seems to have fewer bleeding complications with an equivalent efficacy, as compared to alteplase, in Korean patients who suffer with massive pulmonary thromboembolism.
Fibrinolytic Agents ; Hemorrhage ; Humans ; Length of Stay ; Plasminogen ; Pulmonary Embolism ; Respiration, Artificial ; Retrospective Studies ; Tissue Plasminogen Activator ; Urokinase-Type Plasminogen Activator ; Vasoconstrictor Agents

BACKGROUND: Granulocyte stimulating factor (G-CSF) and bone marrow mononuclear cells (BM-MNC) were reported to improve cardiac function after myocardial infarction (MI). This study was to examine their combined beneficial effects and mechanisms of actions in reperfused MI, which have not been verified yet. METHODS:Fifteen pigs were divided into 3 groups after a 1-hour balloon occlusion and reperfusion of the left anterior descending coronary artery. G1 (n=5) was a control, G2 (n=5) was a G-CSF injected group (10 ug/kg/day, from day1 to day7 after MI), and G3 (n=5) was an autologous intracoronary BM-MNC infused group after G-CSF treatment RESULTS:Modified wall motion indices by echocardiography were similar among 3 groups at 24 hours after MI. However, they improved significantly in G2 and G3 at 35days after MI (p<0.05). The percentage of infarct area/left ventricular myocardial area measured from a triphenyltetrazolium chloride (TTC) stain was lower in G3 than in G1 or G2 (p=0.026). The number of vWF-positive vessels and the expressions of vWF and VE cardherin by RT-PCR were higher in G3 and G2 than in G1 (p<0.05). The number of TUNEL-positive cells and bcl2/bax ratio were not significantly different among 3 groups. CONCLUSION: This study suggests that intracoronary BM-MNC infusion with G-CSF treatment in reperfused MI reduced infarct size, improved left ventricular function and prevented ventricular remodeling.
Balloon Occlusion ; Bone Marrow ; Coronary Vessels ; Echocardiography ; Granulocyte Colony-Stimulating Factor ; Granulocytes ; Myocardial Infarction ; Reperfusion ; Swine ; Tetrazolium Salts ; Ventricular Function, Left ; Ventricular Remodeling

An acute pulmonary embolism (PE) and the apical ballooning syndrome (ABS) are both critical and need proper management during the acute stage. We experienced a case of recurrent severe dyspnea because serious right ventricular dysfunction due to PE and left ventricular dysfunction due to ABS occurred consecutively in the short-term and bedside echocardiography has an important role in management in acute settings.
Dyspnea ; Echocardiography ; Hemorrhage ; Pulmonary Embolism ; Takotsubo Cardiomyopathy ; Ventricular Dysfunction, Left ; Ventricular Dysfunction, Right