Background: With the introduction of Xpert MTB/RIF assay (Xpert), its incorporation into tuberculosis (TB) diagnostic algorithm has become an important issue. The aim of this study was to evaluate the performance of the Xpert assay in comparison with a commercial polymerase chain reaction (PCR) assay. Methods: Medical records of patients having results of both Xpert and AdvanSure TB/NTM real-time PCR (AdvanSure) assays using the same bronchial washing specimens were retrospectively reviewed. Results: Of the 1,297 patients included in this study, 205 (15.8%) were diagnosed with pulmonary TB. Using mycobacterial culture as the reference method, sensitivity of the Xpert assay using smear-positive specimens was 97.5%, which was comparable to that of the AdvanSure assay (96.3%, p=0.193). However, the sensitivity of the Xpert assay using smear-negative specimens was 70.6%, which was significantly higher than that of the AdvanSure assay (52.9%, p=0.018). Usng phenotypic drug susceptibility testing as the reference method, sensitivity and specificity for detecting rifampicin resistance were 100% and 99.1%, respectively. Moreover, a median turnaround time of the Xpert assay was 1 day, which was significantly shorter than 3 days of the AdvanSure assay (p<0.001). Conclusion In comparison with the AdvanSure assay, the Xpert assay had a higher sensitivity using smear-negative specimens, a shorter turnaround time, and could reliably predict rifampin resistance. Therefore, the Xpert assay might be preferentially recommended over TB-PCR in Korean TB diagnostic algorithm.

BACKGROUND/AIMS: Several epidemiological studies have validated the association of interleukin gene polymorphisms with acute pancreatitis (AP) in different populations. However, there have been few studies in Asian ethnic groups. We aimed to investigate the relationships between inflammatory cytokine polymorphisms and AP as pilot research in a Korean ethnic group. METHODS: Patients who had been diagnosed with AP were prospectively enrolled. DNA was extracted from whole blood, and DNA sequencing was subsequently performed. Single-nucleotide polymorphisms (SNPs) of the interleukin 1β (IL1B), interleukin 1 receptor antagonist (IL1RN), and tumor necrosis factor α (TNFA) genes of patients with AP were compared to those of normal controls. RESULTS: Between January 2011 and January 2013, a total of 65 subjects were enrolled (40 patients with AP vs. 25 healthy controls). One intronic SNP (IL1RN −1129T>C, rs4251961) was significantly associated with the risk of AP (odds ratio, 0.304; 95% confidence interval, 0.095 to 0.967; p = 0.043). However, in our study, AP was not found to be associated with polymorphisms in the promoter regions of inflammatory cytokine genes, including IL1B (−118C>T, c47+242C>T, +3954C/T, and −598T>C) and TNFA (−1211T>C, −1043C>A, −1037C>T, −488G>A, and −418G>A). CONCLUSIONS: IL1RN −1129T>C (rs4251961) genotypes might be associated with a significant increase of AP risk in a Korean ethnic group.
Asian Continental Ancestry Group ; DNA ; Epidemiologic Studies ; Ethnic Groups* ; Genotype ; Humans ; Interleukins ; Introns ; Pancreatitis* ; Polymorphism, Genetic* ; Polymorphism, Single Nucleotide ; Promoter Regions, Genetic ; Prospective Studies ; Receptors, Interleukin-1 ; Sequence Analysis, DNA ; Tumor Necrosis Factor-alpha

A 22-year-old woman with a 1-month history of shortness of breath that was treated as a case of tuberculosis and pulmonary embolism was referred to the authors’ hospital. Because of the hemodynamic instability in this patient, venoarterial extracorporeal membrane oxygenation (ECMO) was administered in the intensive care unit. She underwent a pulmonary embolectomy for the treatment of progressive circulatory collapse secondary to a pulmonary embolism. The histopathologic result was consistent with a metastatic choriocarcinoma. Despite the surgical management, persistent refractory cardiogenic shock occurred. Subsequently, the patient was treated with chemotherapy in the presence of ECMO and responded well to chemotherapy. She was discharged after 3 months. This case suggests that metastatic choriocarcinoma should be considered as a differential diagnosis in women of childbearing age presenting with a pulmonary embolism, and ECMO may be beneficial in patients with pulmonary embolism for bridging to surgical embolectomy and chemotherapy.
Choriocarcinoma* ; Diagnosis, Differential ; Drug Therapy* ; Dyspnea ; Embolectomy ; Extracorporeal Membrane Oxygenation* ; Female ; Hemodynamics ; Humans ; Intensive Care Units ; Neoplastic Cells, Circulating* ; Pregnancy ; Pulmonary Embolism ; Shock ; Shock, Cardiogenic ; Tuberculosis ; Young Adult

BACKGROUND AND OBJECTIVES: The recent increase in the reported incidence of congenital cholesteatoma (CC) may be secondary to the widespread use of otoendoscopy as well as an increased awareness of these lesions among primary care physicians. However, little research about CC has been conducted in a large group of patients. This study aimed to analyze the clinical characteristics of CC including the annual number of patients, symptoms, age at diagnosis, stage and type of disease, surgical techniques, recurrence, and postoperative complications. SUBJECTS AND METHODS: Retrospective chart review was performed for patients who met the inclusion criteria between January 1997 and June 2012. RESULTS: Ninety-three patients underwent surgery for CC. The age at operation ranged from 12 months to 17 years (mean age, 6.1 years). The number of patients was less than 4 per year until 2005, but increased to more than 10 per year since 2008. CC was most commonly reported as an incidental finding (58.1%). The operative procedures included the transcanal myringotomy approach (46.2%), canal wall up mastoidectomy (37.6%), tympanoplasty (8.6%), and canal wall down mastoidectomy (7.5%). The recurrence rate was 20.4% and the complication rate was 12.9%. No patients with stage I CC had complications. CONCLUSIONS: This study showed that the incidence of CC has recently increased notably. Most patients with stage I and II CC were completely cured by transtympanic surgery, and complication and recurrence rates increased according to the extent of disease. Early detection of CC is important to facilitate minimally invasive surgery and to reduce complication and recurrence rates.
Child* ; Cholesteatoma* ; Diagnosis ; Humans ; Incidence ; Incidental Findings ; Minimally Invasive Surgical Procedures ; Physicians, Primary Care ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative ; Tympanoplasty

PURPOSE: Wnt signaling plays an essential role in the dental epithelium and mesenchyme during tooth morphogenesis. Deletion of the Wntless (Wls) gene in odontoblasts appears to reduce canonical Wnt activity, leading to inhibition of odontoblast maturation. However, it remains unclear if autonomous Wnt ligands are necessary for differentiation of dental pulp cells into odontoblast-like cells to induce reparative dentinogenesis, one of well-known feature of pulp repair to form tertiary dentin. MATERIALS AND METHODS: To analyze the autonomous role of Wls for differentiation of dental pulp cells into odontoblast-like cells, we used primary dental pulp cells from unerupted molars of Wls-floxed allele mouse after infection with adenovirus for Cre recombinase expression to knockout the floxed Wls gene or control GFP expression. The differentiation of dental pulp cells into odontoblast-like cells was analyzed by quantitative real-time polymerase chain reaction. RESULT: Proliferation rate was significantly decreased in dental pulp cells with Cre expression for Wls knockout. The expression levels of Osterix (Osx), runt-related transcription factor 2 (Runx2), and nuclear factor I-C (Nfic) were all significantly decreased by 0.3-fold, 0.2-fold, and 0.3-fold respectively in dental pulp cells with Wls knockout. In addition, the expression levels of Bsp, Col1a1, Opn, and Alpl were significantly decreased by 0.7-fold, 0.3-fold, 0.8-fold, and 0.6-fold respectively in dental pulp cells with Wls knockout. CONCLUSION: Wnt ligands produced autonomously are necessary for proper proliferation and odontoblastic differentiation of mouse dental pulp cells toward further tertiary dentinogenesis.
Adenoviridae ; Alleles ; Animals ; Dental Pulp* ; Dentin ; Dentinogenesis ; Epithelium ; Ligands ; Mesoderm ; Mice* ; Molar ; Morphogenesis ; NFI Transcription Factors ; Odontoblasts* ; Real-Time Polymerase Chain Reaction ; Recombinases ; Tooth ; Transcription Factors

BACKGROUND AND OBJECTIVES: It is well established that cochlear implantation provides significant benefits for prelingually profound deaf children. However, there are few studies that examined the long-term outcome of cochlear implantation beyond 10 years in prelingually deaf children. The purpose of this study was to examine the long-term benefit of cochlear implantation for children with more than 10 years of experience of using cochlear implantation, regarding auditory performance and academic status. We then determined the age effect of cochlear implantation on auditory performance for prelingually deaf children. SUBJECTS AND METHOD: The longitudinal development of auditory performance of 119 deaf children was analyzed after cochlear implantation. Among the 119 children, 58 were included for analysis. RESULTS: The children who received cochlear implanst at younger age showed significantly better auditory performance. Age at which implantation had been performed had a significant effect on the development of auditory performance before 4 years of age. Many children continued to demonstrate improvements of auditory performance upto five years of implant use. Some showed development of auditory performance upto 10 years cochlear implantation. CONCLUSION: The present result indicates that speech perception and performance for children continue to improve over time from 5 upto 10 years while using cochlear implant. The use of earlier cochlear implantation was demonstrated to provide better auditory performance. The age at which implantation was performed was one of the important factors influencing the long-term outcome of cochlear implantation.
Child* ; Cochlear Implantation* ; Cochlear Implants* ; Humans ; Language Development* ; Methods ; Speech Perception

Molecular interactions between epithelium and mesenchyme are important for root formation. Nuclear factor I-C (Nfic) has been identified as a key regulator of root formation. However, the mechanisms of root formation and their interactions between Hertwig's epithelial root sheath (HERS) and mesenchyme remain unclear. In this study, we investigated the role of Nfic in root patterning and growth during molar root development. The molars of Nfic knockout mice exhibited an enlarged pulp chamber and apical displacement of the pulpal floor, characteristic features of taurodontism, due to delayed furcation formation. In developing molar roots of mutant mice at P14, BrdU positive cells decreased in the apical mesenchyme of the elongation region whereas those cells increased in the dental papilla of the furcation region. Whereas cytokeratin 14 and laminin were localized in HERS cells of mutant molars, Smoothened (Smo) and Gli1 were downregulated in preodontoblasts. In contrast, cytokeratin 14 and Smo were localized in the cells of the furcation region of mutant molars. These results indicate that Nfic regulates cell proliferation in the dental mesenchyme and affects the fate of HERS cells in a site-specific manner. From the results, it is suggested that Nfic is required for root patterning and growth during root morphogenesis.
Animals ; Bromodeoxyuridine ; Cell Proliferation ; Dental Papilla ; Dental Pulp Cavity ; Epithelium ; Keratin-14 ; Laminin ; Mesoderm ; Mice ; Mice, Knockout ; Molar ; Morphogenesis ; NFI Transcription Factors ; Tooth Root* ; Tooth*

We made two mistakes in our recently published article. We are correcting the authorship and funding information.
Ear, Middle/*pathology ; Humans ; Otitis Media/*pathology ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, Optical Coherence/*methods

A 60-year-old woman presented with cerebellar signs including dysarthria and ataxia, after intravenous infusion of cisplatin-based chemotherapy. Several blood tests showed mild neutropenia, normocytic normochromic anemia, but no evidence of a marked hyponatremia. Brain magnetic resonance imaging with diffusion-weighted sequences showed hyper-intense signal abnormalities in the extrapontine region, sparing the basis pontis. Here, we report on the case of a patient with reversible cerebellar ataxia related to extrapontine myelinolysis without hyponatremia after treatment with cisplatin-based chemotherapy for cholangiocarcinoma and discuss the literature on cerebellar ataxia in patients who underwent recent chemotherapy for malignancy.
Anemia ; Ataxia ; Brain ; Cerebellar Ataxia* ; Cholangiocarcinoma* ; Cisplatin ; Drug Therapy* ; Dysarthria ; Female ; Hematologic Tests ; Humans ; Hyponatremia* ; Infusions, Intravenous ; Magnetic Resonance Imaging ; Middle Aged ; Myelinolysis, Central Pontine* ; Neutropenia

We report the application of optical coherence tomography (OCT) to the diagnosis and evaluation of otitis media (OM). Whereas conventional diagnostic modalities for OM, including standard and pneumatic otoscopy, are limited to visualizing the surface of the tympanic membrane (TM), OCT effectively reveals the depth-resolved microstructure below the TM with very high spatial resolution, with the potential advantage of its use for diagnosing different types of OM. We examined the use of 840-nm spectral domain-OCT (SD-OCT) clinically, using normal ears and ears with the adhesive and effusion types of OM. Specific features were identified in two-dimensional OCT images of abnormal TMs, compared to images of healthy TMs. Analysis of the A-scan (axial depth scan) identified unique patterns of constituents within the effusions. The OCT images could not only be used to construct a database for the diagnosis and classification of OM but OCT might also represent an upgrade over current otoscopy techniques.
Adult ; Ear Canal/anatomy & histology ; Eustachian Tube/physiology ; Female ; Humans ; Male ; Middle Aged ; Otitis Media/classification/*diagnosis ; Tomography, Optical Coherence/instrumentation/*methods ; Tympanic Membrane/*physiology