Risk factors for the delayed diagnosis of extrapulmonary TB

BACKGROUND: Extrapulmonary TB (EPTB) is more difficult to diagnose than pulmonary TB. The delayed management of EPTB can lead to complications and increase the socio-economic burden.METHODS: Patients newly diagnosed with EPTB were retrospectively enrolled from 11 general hospitals in South Korea from January 2017 to December 2018. The basic characteristics of patients were described. Univariable and multivariable analyses were performed between early and delayed diagnosis groups to identify risk factors for delayed diagnosis and treatment in EPTB.RESULTS: In total, 594 patients were enrolled. Lymph node TB (28.3%) was the predominant form, followed by abdominal (18.4%) and disseminated TB (14.5%). Concurrent lung involvement was 17.8%. The positivity of diagnostic tests showed no significant difference between the two groups. Acute clinical manifestations in disseminated, pericardial and meningeal TB, and immunosuppression were associated with early diagnosis. Delayed diagnosis was associated with outpatient clinic visits, delayed sample acquisition and diagnostic departments other than infection or pulmonology.CONCLUSION: The delay in diagnosis and treatment of EPTB was not related to differences in microbiological characteristics of Mycobacterium tuberculosis itself; rather, it was due to the indolent clinical manifestations that cause referral to non-TB-specialised departments in the outpatient clinic and delay the suspicion of TB and diagnostic testing.

Extrapleural solitary fibrous tumor of the thyroid gland: A case report and review of literature

BACKGROUND

Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm that arises from the pleura. A few SFTs have also been described in extrapleural sites. However, SFT of the thyroid gland is rare. Here, we report a case of extrapleural SFT on the thyroid gland, in addition to a literature review.

CASE SUMMARY

A 59-year-old man visited our hospital in July 2017 complaining of a large mass in his neck. His thyroid function test results, including antibody levels, were within the normal limits. Ultrasonography showed a 4.7 cm × 4.0 cm × 3.2 cm solitary mass of intermediate suspicion in the left thyroid lobe. A fine-needle aspiration biopsy was subsequently performed. The pathologist reported a benign follicular lesion. However, the size of this nodule increased to 5.5 cm × 5.0 cm × 3.4 cm by April 2018. After a multidisciplinary discussion, a left lobectomy was performed in May 2018. The specimen showed a well-demarcated, partly encapsulated, soft nodule of whitish and tan/brown color on the cut surface. Light microscopy revealed high cellularity with moderate cytologic atypia. The mitotic count was 5/10 high-power fields. There was no tumor necrosis or lymphovascular invasion. The tumor was CD34-positive and signal transducer and activator of transcription 6-positive. Neither thyroid transcription factor-1 nor cytokeratin expression was detected. The Ki-67 showed intermediate proliferative activity. The final diagnosis was extrapleural SFT of the thyroid gland with a clear resection margin. The patient was discharged without complication three days after the surgery.

CONCLUSION

In the literature, extrapleural SFT of the thyroid gland has been reported to behave indolently with the capacity for recurrence and rare metastasis, although surgical resection is the treatment of choice. Understanding this disease entity is important for accurate diagnosis and proper management.

Timing of antibiotics in septic patients: a prospective cohort study

OBJECTIVES

To evaluate the effect of timing and appropriateness of antibiotics administration on mortality in patients diagnosed with sepsis according to the Sepsis-3 definition.

METHODS

This prospective cohort study was conducted in patients diagnosed with sepsis according to the Sepsis-3 definition at the emergency department of Korea University Ansan Hospital from January 2016 to January 2019. The time to antibiotics was defined as the time in hours from emergency department arrival to the first antibiotic administration. Cox proportional hazards regression analysis was used to estimate the association between time to antibiotics and 7-, 14- and 28-day mortality.

RESULTS

Of 482 patients enrolled onto this study, 203 (42.1%) of 482 and 312 (64.7%) of 482 were diagnosed with septic shock and high-grade infection respectively. The median time to receipt of antibiotic therapy was 115 minutes. Antibiotics were administered within 3 and 6 hours in 340 (70.4%) of 482 and 450 (93.2%) of 482 patients respectively. Initial appropriate empirical antibiotics were administered in 375 (77.8%) of 482 patients. The time to and appropriateness of the initial antibiotics were not associated with 7-, 14- and 28-day mortality in multivariate analysis. The Sequential Organ Failure Assessment (SOFA) score (adjusted hazard ratio (aHR) 1.229, 95% confidence interval (CI) 1.093-1.381, p 0.001) and initial lactate levels (aHR 1.128, 95% CI 1.034-1.230, p 0.007), Charlson comorbidity index (aHR 1.115, 95% CI 1.027-1.210, p 0.014), 2-hour lactate level (aHR 1.115, 95% CI 1.027-1.210, p 0.009) and SOFA score (aHR 1.077, 95% CI 1.013-1.144, p 0.018) affected 7-, 14- and 28-day mortality respectively. Subgroup analysis with septic shock, bacteraemia and high-grade infection did not affect mortality rates.

CONCLUSIONS

Time to receipt of antibiotics may not affect the prognosis of patients with sepsis if a rapid and well-trained resuscitation is combined with appropriate antibiotic administration within a reasonable time.

Impact of antimicrobial treatment duration on outcome of Staphylococcus aureus bacteraemia: a cohort study

OBJECTIVES

To assess the outcome of Staphylococcus aureus bacteraemia (SAB) according to factors associated with necessity for longer treatment in conjunction with the duration of treatment.

METHODS

We prospectively collected the data of patients with SAB consecutively during 12 to 39 months from 11 hospitals. If multiple episodes of SAB occurred in one patient, only the first episode was enrolled. Factors associated with necessity for longer treatment were defined as follows: persistent bacteraemia, metastatic infection, prosthesis and endocarditis. If any of the factors were present, then the case was defined as longer antibiotic treatment warranted (LW) group; those without any factors were defined as shorter antibiotic treatment sufficient (SS) group. Poor outcome was defined as a composite of 90-day mortality or 30-day recurrence. Duration of antibiotic administration was classified as <14 or ≥14 days in the SS group and <28 or ≥28 days in the LW group.

RESULTS

Among 2098 cases, the outcome was analysed in 1866 cases, of which 591 showed poor outcome. The SS group accounted for 964 cases and the LW group for 852. On multivariate analysis, age over 65 years, pneumonia, higher Sequential Organ Failure Assessment (SOFA) score and chronic liver diseases were risk factors for poor outcome. Administration of antibiotics less than the recommendation was associated with poor outcome, but this significance was observed only in the LW group (adjusted odds ratio = 1.68; 95% confidence interval, 1.00-2.83; p 0.05).

CONCLUSIONS

Inappropriately short antibiotic treatment was associated with poor outcome in the LW group. Vigilant evaluation for risk factors to determine the duration of treatment may improve the outcome among patients with SAB.

Benefits of active middle ear implants over hearing aids in patients with sloping high tone hearing loss: comparison with hearing aids

In this retrospective chart review we compared the subjective and objective benefits of active middle ear implants (AMEIs) with conventional hearing aids (HAs) in patients with sloping high tone hearing loss. Thirty-four patients with sensorineural hearing loss were treated with AMEIs. Of these, six had sloping high tone hearing loss and had worn an HA for more than 6 months. Objective assessments, a pure-tone audiogram, as well as a word recognition test, and the Korean version of the Hearing in Noise Test (K-HINT), and a subjective assessment, the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, were performed. Tests were conducted under three circumstances: 1) the unaided state before surgery; 2) the HA-aided state before surgery; and 3) the AMEI-aided state 3 months after surgery. The average high-frequency hearing gain (≥ 2 kHz) was significantly better with AMEIs than with HAs. Although the result had no statistical significance, AMEIs showed a superior word recognition score (WRS) compared to HAs. However, the most comfortable hearing level at which the WRS was tested was significantly decreased with an AMEI compared to an HA. In the K-HINT, patients with an AMEI showed greater recognition than those fitted with an HA under both quiet and noisy conditions. The APAHB scores revealed that patients were more satisfied with an AMEI rather than an HA on all subscales. The use of vibroplasty in patients with sloping high tone loss resulted in positive hearing outcomes when compared to conventional HAs. Based on the data from this study, AMEIs provided better objective and subjective results and could, therefore, be a better alternative for the treatment of sloping hearing loss.

Acute toxicity of organic antifouling biocides to phytoplankton Nitzschia pungens and zooplankton Artemia larvae

The toxicity of the antifouling biocides Irgarol 1051, Diuron, Chlorothalonil, Dichlofluanid, Sea-nine 211, Copper pyrithione, Zinc pyrithione, Ziram and Zineb were evaluated on Nitzschia pungens and Artemia larvae. Results showed that EC₅₀ for Irgarol 1051 was 0.586μgl^-1 was the strongest effect on N. pungens following by Copper pyrithione (4.908μgl^-1), Ziram (5.421μgl^-1), Zinc pyrithione (5.513μgl^-1), Diuron (6.640μgl^-1), Zineb (232.249μgl^-1), Sea-nine 211(267.368μgl^-1), Chlorothalonil (360.963μgl^-1) and Dichlofluanid (377.010μgl^-1) in 96h. In Artemia larvae, the biocides were evaluated the LC₅₀ for larval survivals at 48h. Sea-nine 211 and Copper pyrithione were 0.318 and 0.319mgl^-1. Chlorothalonil, Zinc pyrithione and Ziram were 2.683, 3.147 and 4.778mgl^-1. Irgarol 1051, Diuron, Zineb and Dichlofluanid were 9.734, 30.573, 41.170 and 154.944mgl^-1. These results provide baseline data concerning the toxicity of antifouling biocides against marine environment.

Association of high-dose postoperative opioids with recurrence risk in esophageal squamous cell carcinoma: reinterpreting ERAS protocols for long-term oncologic surgery outcomes

Esophageal squamous cell carcinoma (ESCC) is associated with a poor prognosis and high postoperative recurrence rate. Although postoperative opioid use has been associated with cancer recurrence, its relevance in ESCC has not been determined. Therefore, this study investigated whether high-dose postoperative opioid use was associated with recurrence risk in patients with ESCC. For this retrospective analysis, the medical records of patients who were diagnosed with ESCC and who underwent surgery between January 2006 and December 2010 in the National Cancer Center, Korea were evaluated. Total opioid administration over a 10-day period, from during surgery to postoperative day 9, was calculated. A cutoff value was determined using receiver operating characteristic curve analysis, and patients were classified into the high-use and low-use groups. The primary and secondary outcomes of the study were freedom from recurrence and overall survival, respectively. After propensity score matching, the effect of opioid use on freedom from recurrence and overall survival was evaluated using the Kaplan-Meier method. The final analysis set included 258 patients. The cumulative opioid dose cutoff point was 1783.5 mg of oral morphine. High-dose postoperative opioid use was a significant factor affecting recurrence (Hazard ratio [HR], 2.162; 95% confidence interval [CI], 1.583-2.954; P < 0.0001). In contrast, postoperative opioid use was not associated with death (HR, 1.274; 95% CI, 0.922-1.761; P = 0.1422). In patients with ESCC, compared with low-dose opioid use, high-dose intraoperative and postoperative opioid use was significantly associated with an increased risk of recurrence. However, opioid dosage did not affect overall survival.

Robot-assisted laparoscopic adenomyomectomy of adenomyotic nodule implanted in the uterine endometrium manifesting as endometrial cancer: a case report and literature review

Thickened uterine endometrium with abnormal uterine bleeding highly suggests endometrial hyperplasia or endometrial carcinoma. A case of 35-year-old nulliparous woman came to our department with endometrial mass manifesting as endometrial cancer. Transrectal ultrasonography and magnetic resonance imaging (MRI) showed an 8x6 cm multicystic, ill-defined mass compacted at the uterine endometrium, the anterior wall of the uterus, and 3x3 cm heterogenous mass at the left adnexa. The edometrial mass showed multiple septations with enhancement and low-signal intensity on T2-weighted images. After endometrial biopsy was done and simple hyperplasia without atypia was observed at the histopathologic finding, the patient underwent robot-assisted laparoscopy and diagnosed as adenomyoma at the frozen pathology. After adenomyomectomy, permanent pathologic analysis revealed the same result and she recovered without any complications and responded well to gonadotropin-releasing hormone (GnRH) agonist therapy.

Ureteral obstruction following renal transplantation: causes, diagnosis and management

Renal transplantation, first performed successfully in the 1950s, is the treatment of choice for most patients with end-stage renal failure. It confers longer term survival and a better quality of life than do both haemodialysis and peritoneal dialysis. The success of renal transplantation is dependent on the preservation of renal graft function and despite the many advances in surgical techniques, immunosuppressive regimens and supportive therapies, many challenges remain including post-operative ureteral obstruction. This complication can pose a risk to graft, and, occasionally, to patient survival. In this pictorial review, we describe the causes of ureteral obstruction following renal transplantation and illustrate the pivotal role of radiology in both diagnosing and managing these complications.

Graft-bending angle and femoral tunnel length after single-bundle anterior cruciate ligament reconstruction: comparison of the transtibial, anteromedial portal and outside-in techniques

We used immediate post-operative in vivo three-dimensional computed tomography to compare graft bending angles and femoral tunnel lengths in 155 patients who had undergone single-bundle reconstruction of the anterior cruciate ligament using the transtibial (n = 37), anteromedial portal (n = 72) and outside-in (n = 46) techniques. The bending angles in the sagittal and axial planes were significantly greater but the coronal-bending angle was significantly less in the transtibial group than in the anteromedial portal and outside-in groups (p < 0.001 each). The mean length of the femoral tunnel in all three planes was significantly greater in the transtibial group than the anteromedial portal and outside-in groups (p < 0.001 each), but all mean tunnel lengths in the three groups exceeded 30 mm. The only significant difference was the coronal graft- bending angle in the anteromedial portal and outside-in groups (23.5° vs 29.8°, p = 0.012). Compared with the transtibial technique, the anteromedial portal and outside-in techniques may reduce the graft-bending stress at the opening of the femoral tunnel. Despite the femoral tunnel length being shorter in the anteromedial portal and outside-in techniques than in the transtibial technique, a femoral tunnel length of more than 30 mm in the anteromedial portal and outside-in techniques may be sufficient for the graft to heal.

Dynamics of air temperature, velocity and ammonia emissions in enclosed and conventional pig housing systems

This study aimed to compare the dynamics of air temperature and velocity under two different ventilation and housing systems during summer and winter in Korea. The NH₃ concentration of both housing systems was also investigated in relation to the pig’s growth. The ventilation systems used were; negative pressure type for the enclosed pig house (EPH) and natural airflow for the conventional pig house (CPH). Against a highly fluctuating outdoor temperature, the EPH was able to maintain a stable temperature at 24.8 to 29.1°C during summer and 17.9 to 23.1°C during winter whilst the CPH had a wider temperature variance during summer at 24.7 to 32.3°C. However, the temperature fluctuation of the CPH during winter was almost the same with that of EPH at 14.5 to 18.2°C. The NH₃ levels in the CPH ranged from 9.31 to 16.9 mg/L during summer and 5.1 to 19.7 mg/L during winter whilst that of the EPH pig house was 7.9 to 16.1 mg/L and 3.7 to 9.6 mg/L during summer and winter, respectively. These values were less than the critical ammonia level for pigs with the EPH maintaining a lower level than the CPH in both winter and summer. The air velocity at pig nose level in the EPH during summer was 0.23 m/s, enough to provide comfort because of the unique design of the inlet feature. However, no air movement was observed in almost all the lower portions of the CPH during winter because of the absence of an inlet feature. There was a significant improvement in weight gain and feed intake of pigs reared in the EPH compared to the CPH (p<0.05). These findings proved that despite the difference in the housing systems, a stable indoor temperature was necessary to minimize the impact of an avoidable and highly fluctuating outdoor temperature. The EPH consistently maintained an effective indoor airspeed irrespective of season; however the CPH had defective and stagnant air at pig nose level during winter. Characteristics of airflow direction and pattern were consistent relative to housing system during both summer and winter but not of airspeed. The ideal air velocity measurement favored the EPH and therefore can be appropriate for the Korean environment. Further emphasis on its cost effectiveness will be the subject of future investigations.

Clinical impact of microscopic extrathyroidal extension in patients with papillary thyroid microcarcinoma treated with hemithyroidectomy

BACKGROUND

Pathologically confirmed microscopic extrathyroidal extension (ETE) is often identified after hemithyroidectomy in patients with papillary thyroid microcarcinoma (PTMC). Without the presence of microscopic ETE, these patients would be optimal candidates for hemithyroidectomy.

AIM

The present study aimed at evaluating the clinical impact of microscopic ETE on the recurrence of PTMC treated with hemithyroidectomy.

SUBJECTS AND METHODS

We compared the clinicopathological characteristics and 5-year outcomes for 262 PTMC patients without ETE and 86 with microscopic ETE who were treated with hemithyroidectomy between January 2004 and December 2010.

RESULTS

The mean tumour size was larger (0.67 vs. 0.54 cm, p < 0.001) and the proportion of tumours measuring ≥0.5 cm was higher (84.9 vs. 66.8 %, p = 0.001) in patients with microscopic ETE as compared with patients without ETE. Occult multifocal disease was more frequent in patients with microscopic ETE than in those without ETE (14.0 vs. 6.5 %, p = 0.030). However, the recurrence rate was not different between the two groups during the mean 55.8-month follow-up period. In addition, univariate and multivariate analyses revealed no meaningful association between recurrence and microscopic ETE in patients with PTMC treated with hemithyroidectomy.

CONCLUSIONS

Although microscopic ETE was associated with large tumour size and multifocal disease, its clinical impact on disease recurrence was not significant in PTMC patients treated with hemithyroidectomy. Therefore, microscopic ETE identified after hemithyroidectomy would not be an absolute indication for completion thyroidectomy in patients with PTMC.

The effects of the combined use of a PDE5 inhibitor and medications for hypertension, lower urinary tract symptoms and dyslipidemia on corporal tissue tone

ED is closely associated with its comorbidities (hypertension, dyslipidemia and lower urinary tract symptoms (LUTS)). Therefore, several drugs have been prescribed simultaneously with PDE5 inhibitors. If a specific medication for ED comorbidities has enhancing effects on PDE5 inhibitors, it offers alternative combination therapy in nonresponders to monotherapy with PDE5 inhibitors and allows clinicians to treat ED and its comorbidities simultaneously. To establish theoretical basis of choosing an appropriate medication for ED and concomitant disease, we examined the effects combining a PDE5 inhibitor with representative drugs for hypertension, dyslipidemia and LUTS on relaxing the corpus cavernosum of rabbits using the organ-bath technique. The effect of mirodenafil on relaxing phenylephrine-induced cavernosal contractions was significantly enhanced by the presence of 10(-4) M losartan, 10(-6) M nifedipine, 10(-6) M amlodipine, 10(-7) M doxazosin and 10(-9) M tamsulosin (P<0.05). The maximum relaxation effects were 47.2±3.8%, 57.6±2.6%, 64.0±3.7%, 76.1±5.7% and 71.7±5.4%, respectively. Enalapril and simvastatin had no enhancing effects. The relaxation induced by sodium nitroprusside alone (39.0±4.0%) was significantly enhanced in the presence of the 10(-4) M losartan (66.0±6.0%, P<0.05). Tetraethylammonium (1 mM) significantly inhibited the enhancement effects of tamsulosin and doxazosin on mirodenafil-induced relaxation (doxazosin: 76.1±5.7% vs 45.3±2.3%; tamsulosin: 71.7±5.4% vs 48.1±3.5%). On the basis of these findings, losartan seemed to induce synergistic effects through an interaction with nitric oxide. In addition, K(+) channel activation could be one of the mechanisms for the synergistic effect of combining mirodenafil with doxazosin or tamsulosin. We believe that the combination of a PDE5 inhibitor with losartan, nifedipine, amlodipine, doxazosin or tamsulosin could be a pharmacologic strategy for simultaneously treating ED and its comorbidities and increasing response rates to PDE5 inhibitors.

Food protective effect of geraniol and its congeners against stored food mites

The acaricidal activities of compounds derived from the oil of Pelargonium graveolens leaves against the storage food mite, Tyrophagus putrescentiae, were compared with the activity of a commercial acaricide, benzyl benzoate, in an impregnated fabric disk bioassay. Purification of the active constituent from P. graveolens was accomplished by silica gel chromatography and high-performance liquid chromatography. Structural analysis of the active constituent by 1H nuclear magnetic resonance (NMR), 13C-NMR, 1H-13C shift correlated spectroscopy NMR, and distortionless enhancement by polarization transfer NMR identified trans-3,7-dimethyl-2,6-octadien-1-ol (geraniol). Based on the 50% lethal dose values, the most toxic compounds against T. putrescentiae were geraniol (1.95 microg/cm3), which was followed by nerol (2.21 microg/cm3), citral (9.65 microg/cm3), benzyl benzoate (11.27 microg/cm3), and beta-citronellol (15.86 microg/cm3). Our results suggest that geraniol is more effective in controlling T. putrescentiae than benzyl benzoate is. Furthermore, geraniol, which is used as a flavoring for beverages, candies, ice creams, and baked goods and congeners (citral and nerol), may be useful for managing populations of T. putrescentiae.

VDUP1 potentiates Ras-mediated angiogenesis via ROS production in endothelial cells

Vitamin D3 up-regulated protein 1 (VDUP1) is a tumor suppressor of which expression is reduced in a variety of cancer cells, and enforced expression inhibits the tumor cell proliferation. It inhibits the activity of thioredoxin, thus contributing cellular ROS generation. Since ROS is a critical factor for angiogenesis, we investigated the role of VDUP1 in angiogenesis and endothelial proliferation. The expression of VDUP1 was upregulated by overexpression of an oncogene, Ras. Enforced expression of VDUP1 increases ROS production and proliferation of Ras-overexpressing endothelial cells. Overexpression of VDUP1 increases the resistance to the anchorage-dependent cell death and tube formation of the Ras-overexpressing endothelial cell. In addition, the removal of ROS by ROS scavenger attenuates the effect of VDUP1 on tube formation. These results suggest that VDUP1 is involved in Ras-mediated angiogenesis via ROS generation in endothelial cells.

Formulations for intermittent release of parathyroid hormone (1-34) and local enhancement of osteoblast activities

The objective of these studies was to develop simple, implantable devices that intermittently release PTH(1-34) and thus could be used for locally stimulating bone formation. The formulations were based on the association polymer system of cellulose acetate phthalate and Pluronic F-127. Release profiles for intermittent devices showed five discrete peaks, whereas sustained devices exhibited zero-order kinetics. Osteoblastic activity was greater for cells intermittently treated with PTH(1-34) compared to sustained exposure. These controlled release devices delivering PTH(1-34) in an intermittent manner may be useful for affecting osteoblast activities in a localized area.

Feasibility of a constructed wetland and wastewater stabilisation pond system as a sewage reclamation system for agricultural reuse in a decentralised rural area

The performance of a constructed wetland (CW) and wastewater stabilisation pond (WSP) system for sewage reclamation and paddy rice irrigation in a decentralised rural area was examined using a feasibility study. The CW was satisfactory for sewage treatment, with good removal efficiency even in the winter period, but the effluent concentration was relatively high in the winter period owing to the high influent concentration. The CW effluent was further treated in a WSP and the WSP effluent was considered safe for crop irrigation with respect to sewage-borne pathogens. Reclaimed water irrigation did not adversely affect the yield of rice; on the contrary, it resulted in an approximately 50% greater yield than in controls. The chemical characteristics of the soil did not change significantly during the experimental period of irrigation with reclaimed water. In the winter, CW effluent could be stored and treated in a WSP until the spring; the water could then be discharged or reused for supplemental irrigation during the typical Korean spring drought. Overall, sewage treatment and agronomic reuse using a CW-WSP system could be a practical integrated sewage management measure for protecting receiving water bodies and overcoming water shortages in decentralised rural areas.

Characteristics of indicator microorganisms in paddy rice plots after reclaimed water irrigation

A study was performed to examine the effects of reclaimed-water irrigation on microorganism concentration in the ponded-water of paddy rice plots. Several treatments were used and each one was triplicated to evaluate the change of indicator microorganisms (total coliforms (TC), faecal coliforms (FC), and E. coli) concentrations in 2003 and 2004 growing seasons. Their concentrations increased significantly after irrigation, but decreased by approximately 45% in 24 h. It implies that agricultural activities such as ploughing and fertilising need to be practiced one or two days after irrigation, considering health risks. Treatments with UV-disinfected water irrigation, demonstrated significantly lower concentrations than others, including control plots where natural water was irrigated. The monitoring result from actual paddy rice fields and experimental paddy plots showed that concentrations of indicator microorganisms ranged from 10(2) to 10(5) MPN/100 mL. The field scale water reuse research project is in progress and national guidelines for reclaimed-water irrigation are under preparation in Korea. A comprehensive assessment of existing agricultural practices and a thorough monitoring in the fields as well as treatment plots are recommended to make national guidelines more representative.

Cloning, expression, and characterization of a methionyl aminopeptidase from a hyperthermophilic archaeon Thermococcus sp. NA1

Genomic analysis of a hyperthermophilic archaeon Thermococcus sp. NA1 revealed the presence of an 885-bp open reading frame encoding a protein of 295 amino acids with a calculated molecular mass of 32,981 Da. Analysis of the deduced amino acid sequence showed that amino acid residues important for catalytic activity and the metal binding ligands conserved in all of methionyl aminopeptidases (MetAP) were also conserved and belonged to type IIa MetAP. The protein, designated TNA1_MetAP (Thermococcus sp. NA1 MetAP), was cloned and expressed in Escherichia coli. The recombinant enzyme was a Mn(2+)-, Ni(2+)-, Fe(2+)-, or Co(2+)-dependent metallopeptidase. Optimal MetAP activity against L: -methionine p-nitroanilide (Met-pNA) (K (m) = 0.68 mM) occurred at pH 7.0 and 80 to 90 degrees C. The MetAP was very unstable compared to Pyrococcus furiosus MetAP, which was completely inactivated by heating at 80 degrees C for 5 min. It seemed likely that the cysteine residue (Cys53) played a critical role in regulating the thermostability of TNA1_MetAP.

Water quality modeling to evaluate BMPs in rice paddies

A water quality model applicable to rice paddies was developed using field data from 1999-2002. Use of the Dirac delta function efficiently explained the nutrient-concentration characteristics of ponded water. The model results agreed reasonably well with the observed data. The ponded-water quality was influenced primarily by fertilization; nutrient concentration was especially high during early cultivation periods. Reducing surface drainage during the fertilization period may substantially reduce nonpoint source loading from paddies. Increased weir heights and shallow irrigation methods were evaluated by the model as practical methods for reducing nutrient loading from paddies. These methods were effective in reducing surface drainage and are suggested as "best management practices" (BMPs) if applied based on site-specific paddy conditions.

Evaluation of BASINS/WinHSPF applicability for pollutant loading estimation for a Korean watershed

Applicability of a widely accepted watershed-based water quality assessment tool (BASINS) and its associated watershed model (WinHSPF) was evaluated on the Seamangeum watershed in Korea. The study site is the largest polder project area in Korea and its environmental quality has been debated for the last five years. BASINS was found to be a convenient and powerful tool for assessment of watershed characteristics, and provided various tools to delineate the watershed into land segments and river reaches, reclassify land use, and parameterize for WinHSPF simulation. Calibration results were satisfactory showing model efficiency over 0.80 for stream flow, temperature, and dissolved oxygen simulation, and model output for water quality constituents also reasonably matched the observed data. It was demonstrated that calibration with dry-day data for a relatively long period might be adequate to simulate hydrologic characteristics and water quality of the watershed with WinHSPF, and using parameters generated with BASINS for nonpoint source pollution simulation is suggested when enough wet-day monitoring data are not available. The unit-area load of biochemical oxygen demand, total nitrogen, and total phosphorus was 27.8, 48.2, and 4.3 kg/ha/yr, respectively. These values are within the expected range but on the high side of the reported values, which implies that effective control measures are required to protect water quality of the downstream reservoir. Overall, BASINS/WinHSPF was applicable and found to be a powerful tool in pollutant loading estimation from the watershed, and its use in Korea is recommended.

Use of a crush-reducing device to decrease crushing of suckling piglets by sows

Weanling pigs tend to avoid wind, and suckling piglets are thought to be more sensitive to wind than weanlings, owing to their thinner s.c. fat layer. We developed a crush-reducing device based on the anticipated behavior of suckling piglets toward wind and evaluated the performance of the device through field testing. The crush-reducing device consisted of six photo sensors, a controller, six solenoid valves, and an air compressor. In this study, 206 sows and their suckling piglets (Landrace xYorkshire) were investigated to ascertain the individual effects of several factors. Some of the newborn piglets were cross-fostered before the crush-reducing device was implemented. Litter weights were measured on d 0 and 4 to determine the influence of the crush-reducing device on the weights of suckling piglets. The crushing of suckling piglets by sows was affected by season (P < 0.01) and litter size (P < 0.05), but not by the parity of the sows; however, the number of crushed piglets per litter was less (P < 0.01) in the crush-reducing device group (0.05 +/- 0.02 crushed piglets/litter) than in the control group (0.23 +/- 0.04 crushed piglets/litter), regardless of litter size or season. The BW gain of suckling piglets did not differ between the control and the crush-reducing device groups. Based on these results, the crush-reducing device is expected to decrease the number of crushed piglets per litter without influencing the BW gain of suckling piglets, thereby greatly contributing to the productivity of pig breeders.

Mass balance analysis and water quality model development for loading estimates from paddy fields

Mass balance analysis and water quality model development for paddy field were performed using field experimental data during 2001-2002. About half (47-62%) of the total outflow was lost by surface drainage, with the remainder (490-530 mm) occurring by evapotranspiration. Most of nutrient inflow and outflow were mediated by fertilization and plant uptake, respectively. Nutrient outflow by surface drainage runoff was substantial about 15%-29% for T-N and 6%-13% for T-P. However, the responses of yield and drainage outflow to fertilization were not significant in this study. A water quality model applicable to paddy fields was developed and it demonstrates good agreement with observed data. The nutrient concentration of ponded water was high by fertilization at early culture periods, so reducing surface drainage during fertilization period can reduce nutrient loading from paddy fields. Shallow irrigation, raising the weir height in diked rice fields, and minimizing forced surface drainage are suggested to reduce surface drainage outflow.

Expression of the hepatitis B surface S and preS2 antigens in tubers of Solanum tuberosum

In an attempt to develop an edible vaccine, we transformed a recombinant hepatitis B virus (HBV) gene encoding the middle protein of HBV that contains the surface S and preS2 antigen into potato by Agrobacterium-mediated transformation. The HBV gene was under control of either the CaMV 35S promoter, the double 35S promoter with the AlMV 5' non-translated leader sequence, or the tuber-specific patatin promoter. HBV mRNA levels were higher with the 35S promoter than with the double 35S and patatin promoters; however, the levels of the S and preS2 antigen in the transformed tubers were higher with the patatin promoter than with the CaMV 35S and double promoters. The levels of preS2 antigen produced are the highest reported to date. Transgenic potato tubers were fed to mice, and the mice showed an immune response against the HBV S antigen.

Implication of co-measured platelet factor 4 in the reliability of the results of the plasma transforming growth factor-beta 1 measurement

We examined the possible alteration of circulating transforming growth factor-beta1 (TGF-beta1) concentrations in a time-dependent fashion in human plasma. Plasma TGF-beta1 was measured three times at 2 week-intervals from each of 12 healthy participants. Platelet factor 4 (PF4) was measured in parallel with TGF-beta1 to estimate the degree of platelet degranulation. TGF-beta1 levels of the second and third plasma samples, in which PF4s were measured as < approximately 1000 IU/ml, were relatively low and fell in a narrow range. However, TGF-beta1 levels of the first samples, in most of which PF4s were > approximately 1000 IU/ml, appeared much higher and more variable than those of the second or third samples. These results indicate that the platelet degranulation accounted for the higher TGF-beta1 levels in the first samples, and thus did not support our initial assumption. We, nevertheless, could propose a useful guidance in the assessment of TGF-beta1 levels in plasma. When the PF4 level is measured as < approximately 1000 IU/ml under our assay conditions, the TGF-beta1 level in a given plasma sample might be accepted as a reliable value considering the effect of platelet degranulation on TGF-beta1 level.

Platelet and cell interactions on gold sputter-deposited polymeric surfaces

Surface treatment as gold sputter-deposited treatment onto various polymeric surfaces has been investigated to improve the cell-, tissue- and blood-compatibility. Surface treated samples were characterized by measurement of contact angle goniometer and electron spectroscopy for chemical analysis (ESCA). The contact angles on the gold-coated polymeric surfaces decreased from 95-65 degrees to around 50 degrees, i.e., increased hydrophilicity due to incorporation of gold thin layer. From the results of ESCA analysis of the modified polymeric surfaces, surface modification by the gold-sputter method was successfully performed. Morphology of the adhered platelets on the gold-coated polymeric surfaces showed lesser activating than control, and the number of adhered platelets surface modified samples decreased with decreasing water contact angle. Fibroblast cell adhesion and growth on the gold-coated polymeric surfaces were more active than those of control. It seems that surface wettability and surface chemistry of gold play important roles for platelet adhesion and cell adhesion, spreading and growth.

Platelet adhesion on the gradient surfaces grafted with phospholipid polymer

We have synthesized omega-methacryloyloxyalkyl phosphorylcholine (MAPC) polymers as new blood-compatible materials, with attention to the surface structure of the biomembrane and investigated their blood compatibility. The blood compatibility observed on the MAPC polymers is due to their strong affinity to phospholipids. When the blood comes in contact with the MAPC polymer, phospholipids in the plasma preferentially adsorb on the surface, compared with the plasma proteins or cells. The adsorbed phospholipids construct a biomembrane-like structure on the MAPC polymer surface. The MAPC polymers then have an excellent blood compatibility. In this study, we prepared a gradient poly(MAPC)-grafted polyethylene (PE) surface using a corona discharge treatment method to clarify the effect of the chemical structure of the MAPC unit on the blood compatibility of the MAPC polymers. The surface composition of MAPC and the hydrophilicity on the poly(MAPC)-grafted PE surface were determined by X-ray photoelectron spectroscopic (XPS) analysis and contact angle measurement with water, respectively. The phosphorus/carbon (P/C) ratio determined by the XPS analysis increased, but the water contact angle decreased with increasing corona irradiation energy. These results indicated that the surface density of the MAPC unit was increased. More than 2.5 cm from the starting point of the corona irradiation, the P/C ratio and water contact angle of the surface achieved a constant level. Thus, the surface was completely covered with the grafted poly(MAPC) chain. The effect of the methylene chain length of the MAPC unit on surface properties was also observed. The phospholipid polar group of the MAPC unit was effectively exposed on the surface as the chain length became longer. Moreover, the hydrophobicity of the surface was increased with the increase in the methylene chain length of the MAPC unit. The number of platelets adhering to the poly(MAPC)-grafted PE surface was reduced from the same point where the P/C ratio became constant.

Cell and platelet adhesions on plasma glow discharge-treated poly(lactide-co-glycolide)

Surface treatment, such as plasma glow discharge treatment, onto poly(lactide-co-glycolide) (PLGA) has been investigated to improve the cell-, tissue- and blood-compatibility. Surface-treated samples were characterized by measurement with a contact angle goniometer and electron spectroscopy for chemical analysis (ESCA). The contact angles on the plasma-treated PLGA surfaces decreased with increasing plasma exposure time from 92 degrees to about 30 degrees, i.e., increased hydrophilicity. From the results of ESCA analysis of plasma-treated films, the incorporation of oxygen molecules into plasma onto the PLGA surface was observed. Cell adhesion and growth on plasma-treated PLGA surfaces were more active than on the control. Furthermore, the maximum adhesion and growth of cells in moderate hydrophilicity were investigated. Morphology of the adhered platelets on the plasma-treated PLGA surface showed less activity than on the control, and the number of adhered platelets on the plasma-exposed PLGA sample decreased with decreasing water contact angle. It seems that surface wettability of PLGA plays an important role in cell adhesion, spreading and growth, and platelet adhesion.

Eosinophil-induced chronic hepatitis

Chronic hepatitis associated with hypereosinophilia has been very rarely reported worldwide. A 7-month-old male infant presented with a high fever, cough, non-projectile vomiting and hepatomegaly. The eosinophil count of the peripheral blood increased up to 21,500/mm3 (49% of WBC). The infant had a history of frequent contact with a neighbor keeping a pigsty. The pathologic examinations of the liver showed severe porto-periportal necroinflammation with marked eosinophilic infiltration, giant cell transformation and ballooning degeneration of hepatocytes, and degranulation of the eosinophils. Bone marrow showed increased eosinophils and decreased myeloid series. Pericardial effusion and bilateral pulmonary consolidation were noted. Corticosteroid aggravated the clinical symptoms of the infant. Anthelmintic treatment significantly normalized the eosinophil count and liver function tests, but cardiopulmonary manifestations continued.

Optical vortices produced with a nonspiral phase plate

We present simple methods to produce optical vortices on the axis of beam propagation with nonspiral phase plates. We show that a phase plate that provides linear phase retardation on one half of a laser beam produces optical vortices, which is demonstrated experimentally by use of a thickness-varying glass platelet. We also demonstrate and explain that mixed dislocations of a bent edge dislocation transform into a pair of vortices with opposing topological charges.

Cloning and characterization of one member of the chalcone synthase gene family from Solanum tuberosum L

We have isolated a chalcone synthase gene 2 (ST-CHS2) from potato by rapid amplification of cDNA ends by PCR. CHS2 cDNA had high homology to tomato LET-CHS2 (98%), petunia PHCHSJ (94%), potato ST-CHS1B (92%), petunia PHCHSA (92%), and LET-CHS1 (90%) at the overall 389-amino acid level. Genomic hybridization analysis indicated that CHS genes of potato comprise a family of at least six individual members.