The continuous emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants has provided insights for updating current coronavirus disease 2019 (COVID-19) vaccines. We examined the neutralizing activity of Abs induced by a BA.4/5-containing bivalent mRNA vaccine against Omicron subvariants BN.1 and XBB.1.5. We recruited 40 individuals who had received a monovalent COVID-19 booster dose after a primary series of COVID-19 vaccinations and will be vaccinated with a BA.4/5-containing bivalent vaccine. Sera were collected before vaccination, one month after, and three months after a bivalent booster.Neutralizing Ab (nAb) titers were measured against ancestral SARS-CoV-2 and Omicron subvariants BA.5, BN.1, and XBB.1.5. BA.4/5-containing bivalent vaccination significantly boosted nAb levels against both ancestral SARS-CoV-2 and Omicron subvariants. Participants with a history of SARS-CoV-2 infection had higher nAb titers against all examined strains than the infection-naïve group. NAb titers against BN.1 and XBB.1.5 were lower than those against the ancestral SARS-CoV-2 and BA.5 strains. These results suggest that COVID-19 vaccinations specifically targeting emerging Omicron subvariants, such as XBB.1.5, may be required to ensure better protection against SARS-CoV-2 infection, especially in high-risk groups.

Background: Type 2 diabetes and cardiovascular disease (CVD) are the most important sequelae of obesity and the leading cause of death. We evaluated the association between body mass index (BMI) and the risk of incident type 2 diabetes, CVD, and all-cause mortality in a prospective study of a Korean population. Methods: The shapes of the associations were modeled by restricted cubic splines regression analysis. After categorizing all subjects (n=8,900) into octiles based on their BMI levels, we estimated the hazard ratio (HR) for the association of categorized BMI levels with the risk of incident CVD and type 2 diabetes using a Cox’s proportional hazard analysis. Results: The mean age of participants was 52 years and 48% were men. Of the subjects at baseline, 39.0% of men and 45.6% of women were classified as obese (BMI ≥25 kg/m2). Over a mean follow-up of 8.1 years, CVD events occurred in 509 participants; 436 died; and 1,258 subjects developed type 2 diabetes. The increased risk of incident diabetes began to be significant at BMI 23 to 24 kg/m2 in both sexes (HR, 1.8). For CVD events, the risk began to increase significantly at BMI 26 to 28 kg/m2 (HR, 1.6). We found a reverse J-shaped relationship between BMI and all-cause mortality, with an increased risk among individuals with BMI values in lower range (BMI <21 kg/m2). Conclusion These results suggest that the BMI cut-off points for observed risk were varied depending on the diseases and that the BMI classification of obesity need to be revised to reflect differential risk of obesity-related diseases.

Influenza virus is one of the major sources of respiratory tract infection. Due to antigenic drift in surface glycoproteins the virus causes annual epidemics with severe morbidity and mortality. Although hemagglutinin (HA) is one of the highly variable surface glycoproteins of the influenza virus, it remains the most attractive target for vaccine development against seasonal influenza infection because antibodies generated against HA provide virus neutralization and subsequent protection against the virus infection. Combination of recombinant adenovirus (rAd) vector-based vaccine and mucosal administration is a promising regimen for safe and effective vaccination against influenza. In this study, we constructed rAd encoding the globular head region of HA from A/Puerto Rico/8/34 virus as vaccine candidate. The rAd vaccine was engineered to express high level of the protein in secreted form. Intranasal or sublingual immunization of mice with the rAd-based vaccine candidates induced significant levels of sustained HA-specific mucosal IgA and IgG. When challenged with lethal dose of homologous virus, the vaccinated mice were completely protected from the infection. The results demonstrate that intranasal or sublingual vaccination with HA-encoding rAd elicits protective immunity against infection with homologous influenza virus. This finding underlines the potential of our recombinant adenovirus-based influenza vaccine candidate for both efficacy and rapid production.
Adenoviridae* ; Administration, Mucosal ; Animals ; Antibodies ; Head* ; Hemagglutinins* ; Immunization* ; Immunoglobulin A ; Immunoglobulin G ; Influenza Vaccines ; Influenza, Human* ; Membrane Glycoproteins ; Mice* ; Mortality ; Orthomyxoviridae* ; Respiratory Tract Infections ; Seasons ; Vaccination ; Viruses

We report an unusual case of osteoblastic metastasis from gastric carcinoma. In this case, bone metastasis was the initial manifestation of the cancer. The laboratory findings revealed mild hypocalcemia and markedly elevated alkaline phosphatase levels. Plain X-ray showed mottled osteoblastic changes in the pelvis. Bone marrow and bone biopsy of the pelvis revealed metastatic adenocarcinoma with increased osteoblastic activity. An extensive search for the primary site revealed advanced gastric carcinoma, which was confirmed by endoscopic biopsy.
Adenocarcinoma/diagnosis/*secondary ; Adult ; Bone Neoplasms/*diagnosis/pathology/*secondary ; Case Report ; Female ; Human ; *Osteoblasts/radiography ; *Pelvis/radiography ; Radionuclide Imaging ; Stomach Neoplasms/*diagnosis ; Tomography, X-Ray Computed

We report an unusual case of osteoblastic metastasis from gastric carcinoma. In this case, bone metastasis was the initial manifestation of the cancer. The laboratory findings revealed mild hypocalcemia and markedly elevated alkaline phosphatase levels. Plain X-ray showed mottled osteoblastic changes in the pelvis. Bone marrow and bone biopsy of the pelvis revealed metastatic adenocarcinoma with increased osteoblastic activity. An extensive search for the primary site revealed advanced gastric carcinoma, which was confirmed by endoscopic biopsy.
Adenocarcinoma/diagnosis/*secondary ; Adult ; Bone Neoplasms/*diagnosis/pathology/*secondary ; Case Report ; Female ; Human ; *Osteoblasts/radiography ; *Pelvis/radiography ; Radionuclide Imaging ; Stomach Neoplasms/*diagnosis ; Tomography, X-Ray Computed

OBJECTIVE: To investigate the immediate effect of dorsal penile nerve (DPN) stimulation on detrusor pressure (Pdet) and blood pressure (BP) during hyper-reflexic contractions of the bladder in patients with cervical spinal cord injury (SCI). METHOD: The subjects were eight male patients with cervical SCI who had symptoms of autonomic dysreflexia. During water-cystometry, BP was monitored using an intra-arterial catheter into the radial artery, and was recorded simultaneously with the Pdet. Electrical stimulation was applied to the DPN, using surface electrodes each time a bladder contraction was detected. Baseline BP and BP at the first and the last hyper-reflexic contractions of bladder were measured with Pdet, respectively. RESULTS: As Pdet increased, the BP increased in all cases. The reflex contractions of the bladder were effectively suppressed by DPN stimulation, and as the Pdet decreased during stimulation, radial arterial pressure also decreased immediately and significantly. CONCLUSION: DPN stimulation can lower both Pdet and the elevated BP.
Arterial Pressure ; Autonomic Dysreflexia ; Blood Pressure* ; Catheters ; Electric Stimulation ; Electrodes ; Humans ; Male ; Pudendal Nerve* ; Radial Artery ; Reflex ; Spinal Cord Injuries ; Urinary Bladder* ; Urinary Bladder, Neurogenic

BACKGROUND: Solitary pulmonary nodule (SPN) may show different pre- sentation in tuberculosis (TB)-endemic countries. The aim of this study was to identify clinical and radiological predictors favoring benign or malignant SPN in TB-endemic region. METHODS: Two hundred one SPNs in 201 consecutive Korean patients were included (< 3 cm in diameter, all confirmed by pathology or bacteriology, 93 benign and 108 malignant diseases). For clinical parameters, age, sex, smoking status and amount, and past history of pulmonary tuberculosis and diabetes mellitus were investigated retrospectively. For radiological parameters, size, location, margin characteristics, presence of calcification, pleural tag, surrounding satellite nodule, cavitation, internal low attenuation, open bronchus sign, surrounding ground-glass opacity, enhancement pattern of the SPNs and mediastinal lymph node (LN) enlargement were analyzed on chest CT scans. RESULTS: Patients with a older age (60.7+/-9.6 vs 56.2+/-13.1, p=0.008) and more than 40-pack years smoking (27.8% vs 14.0%, p=0.017) were more frequently related with malignant than benign SPN. On chest CT scans, spiculated margin, contrast enhancement more than 20 Hounsfield unit and presence of pleural tag and mediastinal LN enlargement were more frequently observed in malignant than benign SPNs. In contrast to previous studies, satellite lesions (21.5% vs 1.9%, p < 0.001) and cavitation (20.4% vs 5.6%, p=0.001) were more frequently seen in benign than malignant SPN. Positive predictive values of benignity were 90.9% and 76.0%, respectively, when satellite lesions and cavitation were found in cases of SPN. CONCLUSION: Satellite lesions and cavitation on chest CT scan could be useful predictors for benign SPN in TB-endemic areas.
Adult ; Age Factors ; Carcinoma/pathology/radiography ; Coin Lesion, Pulmonary/*pathology/*radiography ; Female ; Human ; Korea ; Lung Neoplasms/pathology/radiography ; Male ; Middle Age ; Multivariate Analysis ; Predictive Value of Tests ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/*pathology/*radiography

BACKGROUND: Five year survival rate of postoperative stage I non-small lung cancer(NSCLC) reaches to 66%. In the remaining one third of patients, however, cancer recurs and overall survival of NSCLC remains dismal. To evaluate clinical and pathologic characteristics of recurred NSCLC, we studied patterns and factors for postoperative recurrence in patients with staged I, II NSCLC. METHOD: A retrospective analysis was performed in 234 patients who underwent radical resection for pathologic stage I, II NSCLC. All patients followed for at least one year were included in this study. RESULTS: 1) There were 177 men and 57 women. The median age was 63. The median duration of follow up was 732 days (range 365~1,695 days). The overall recurrence rate was 26.5% and the recurrence occurred at 358.8 +/- 239.8 days after operation. 2) The age of recurred NSCLC patients were higher (63.2 +/- 8.8 years) than that of non-recurred patients (60.3 +/- 9.8 years)(p=0.043). The recurrence rate was higher in stage II (46.9%) than in stage I (18.8%, p<0.001) NSCLC. The size of primary lung mass was larger in recurred (5.45 +/- 3.22 cm) than that of non-recurred NSCLC (3.74 +/- 1.75 cm, p<0.001). Interestingly, there were no recurrent cases when the resected primary tumors were less than 2cm. 3) Distant recurrence was more frequent than locoregional recurrence (66.1% vs. 33.9%). Distant recurrence rate was more frequent in female and adenocarcinoma. Brain metastasis was more frequent in patients with adenocarcinoma than squamous cell carcinoma (p=0.024). CONCLUSION: The tumor size and stage were two important factors for recurrence. Considering that distant brain metastasis was more frequent in patients with adenocarinoma, prospective study should follow to evaluate the effectiveness of preoperative brain imaging.
Adenocarcinoma ; Brain ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Female ; Follow-Up Studies ; Humans ; Lung ; Male ; Neoplasm Metastasis ; Neuroimaging ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

Pseudomembranous colitis, although uncommon, is an important complication of antibiotics that is related to a variety of deleterious effects on the gastrointestinal tract. Rifampicin is one of the 1st line agents in the treatment of tuberculosis and a large number of patients are exposed to its potential adverse effects. We report upon a patient that had diarrhea due to pseudomembranous colitis after receiving antitubeculous medication, and which was probably caused by rifampicin. A 77-year-old man was admitted with diarrhea of three weeks duration. One month previously, he suffered from left pleuritic chest pain and left pleural effusion was noticed at chest X-ray. One week prior to the onset of diarrhea, he was started on empirically isoniazid, rifampicin, ethambutol and pyrazynamide as antituberculous medication. On admission, he complained of diarrhea, left pleuritic chest pain, dyspnea and sputum. On physical examination, breathing sound was decreased in the left lower lung field and bowel sound increased. Pleural biopsy revealed chronic granulomatous infalmmation, which was compatible with tuberculosis. Sigmoidoscopy showed whitish to yellowish pseudomembrane with intervening normal mucosa, and his stool was positive for C.difficle toxin. He was diagnosed as pseudomembranous colitis and treated with oral metronidazole and vancomycin. The diarrhea did not recur after reinstitution of the anti-tuberculous medication without rifampicin. In patients with severe diarrhea receining anti-tuberculous medication, rifampicin induced pseudomembranous colitis should be excluded.
Aged ; Anti-Bacterial Agents ; Biopsy ; Chest Pain ; Clostridium difficile ; Diarrhea ; Dyspnea ; Enterocolitis, Pseudomembranous* ; Ethambutol ; Gastrointestinal Tract ; Humans ; Isoniazid ; Lung ; Metronidazole ; Mucous Membrane ; Physical Examination ; Pleural Effusion ; Respiratory Sounds ; Rifampin* ; Sigmoidoscopy ; Sputum ; Thorax ; Tuberculosis ; Vancomycin

BACKGROUND: Diffuse alveolar hemorrhage (DAH) is rare but often fatal. To determine the clinical manifestations of DAH, its etiology, clinical course and prognosis were studied. METHODS: A retrospective analysis was performed in 21 patients that were diagnosed as DAH. Diagnosis of DAH was based on the presence of the "classical triad" of hemoptysis, anemia, and rapidly progressive infiltrates on chest X-ray and a finding of bronchoalveloar lavage or lung biopsy. RESULTS: Thirteen patients (61.9%) had collagen vascular diseases (CVDs) as underlying disease and 10 patients had systemic lupus erythematosus. Females were more prevalent in CVD than in non-collagen vascular disease (NCVD). Otherwise, there were no significant differences between the two groups in terms of clinical manifestations. Dyspnea (95.2%), cough (76.2%), hemoptysis (61.9%), and fever (33.0%) were frequent symptoms. The initial creatinine level was higher in CVD than in NCVD (3.27±3.15 mg/dl vs. 1.19±0.94 md/dl, p=0.030). The corresponding drop in hemoglobin level was 2.69±1.26 g/dl. Maximal drop in hemoglobin preceded the progression of infiltrates on the chest radiograph by 1.38±4.22 days. The mortality rate was higher in the patients with NCVD than in those with CVD (50.0% vs. 23.1%). CONCLUSION: The DAH can occur not only in patients with CVD but also in those with NCVD. Higher creatinine level CVD in patients is associated with renal involvement in conjunction with DAH. The maximal drop in hemoglobin preceeding the progression of infiltrates on the chest radiograph suggests that the drop in hemoglobin is important for diagnosing DAH.
Anemia ; Biopsy ; Collagen ; Cough ; Creatinine ; Diagnosis ; Dyspnea ; Female ; Fever ; Hemoptysis ; Hemorrhage* ; Humans ; Lung ; Lupus Erythematosus, Systemic ; Mortality ; Prognosis ; Radiography, Thoracic ; Retrospective Studies* ; Therapeutic Irrigation ; Thorax ; Vascular Diseases