Ju-Hyung Lee

Occurrence of disseminated intravascular coagulation (DIC) in active systemic anaphylaxis : role of platelet-activating factor

The possible occurrence of DIC in active systemic anaphylaxis was investigated in mice. Induction of active systemic anaphylaxis resulted in the development of DIC symptoms such as thrombo‐cytopenia, prolongation of prothrombin time, hypofibrinogaemia, and elevated level of fibrinogen/fibrin degradation products. In addition, in histological examinations, massive congestion and cellular infiltration in pulmonary interstitia, and considerable haemorrhage in renal medullae were observed. All these changes were nearly completely prevented by pretreatment with platelet‐activating factor (PAF) antagonist (BN 50739). Moreover, the same haematological and morphological changes were produced by a bolus injection of PAF. These data strongly suggest that DIC occurs in active systemic anaphylaxis and PAF plays a pivotal role in the development of DIC in anaphylaxis.

Adverse reaction of influenza A (H1N1) 2009 virus vaccination in pregnant women and its effect on newborns

Pregnant women are reluctant to be vaccinated during their pregnancy. Their main concern is the safety of influenza vaccine. We investigated the adverse reactions of pregnant women who received the influenza A (H1N1) 2009 virus vaccination and also conditions of neonates of the vaccinated women. Various adverse reactions developed after vaccination, but the symptoms were mild and resolved within several days without requiring any treatment or hospitalization.

Adverse events associated with the 2009 H1N1 influenza vaccination and the vaccination coverage rate in health care workers

We prospectively examined the 2009 H1N1 influenza vaccination coverage rate and the adverse events related to the monovalent vaccine in Korean health care workers. The H1N1 vaccination coverage rate was 91.7%. There were no significant adverse events discouraging the vaccination.

The usefulness of arbekacin compared to vancomycin

The bacteriological efficacy response (improved, arbekacin vs. vancomycin; 71.2% vs. 79.5%) and clinical efficacy response (improved, arbekacin vs. vancomycin; 65.3% vs. 76.1%) were not statistically different between the two groups. The complication rate was significantly higher in the vancomycin group (32.9%) compared to the arbekacin group (15.1%) (p = 0.019). Arbekacin was not inferior to vancomycin, and it could be a good alternative drug for vancomycin in methicillin-resistant Staphylococcus aureus (MRSA) treatment.

Preventive Effect of Korean Red Ginseng for Acute Respiratory Illness: A Randomized and Double-Blind Clinical Trial

Korean Red Ginseng (KRG) is a functional food and has been well known for keeping good health due to its anti-fatigue and immunomodulating activities. However, there is no data on Korean red ginseng for its preventive activity against acute respiratory illness (ARI). The study was conducted in a randomized, double-blinded, placebo-controlled trial in healthy volunteers (Clinical Trial Number: NCT01478009). Our primary efficacy end point was the number of ARI reported and secondary efficacy end point was severity of symptoms, number of symptoms, and duration of ARI. A total of 100 volunteers were enrolled in the study. Fewer subjects in the KRG group reported contracting at least 1 ARI than in the placebo group (12 [24.5%] vs 22 [44.9%], P = 0.034), the difference was statistically significant between the two groups. The symptom duration of the subjects who experienced the ARI, was similar between the two groups (KRG vs placebo; 5.2 ± 2.3 vs 6.3 ± 5.0, P = 0.475). The symptom scores were low tendency in KRG group (KRG vs placebo; 9.5 ± 4.5 vs 17.6 ± 23.1, P = 0.241). The study suggests that KRG may be effective in protecting subjects from contracting ARI, and may have the tendency to decrease the duration and scores of ARI symptoms.

The Efficacy and Safety of Arbekacin and Vancomycin for the Treatment in Skin and Soft Tissue MRSA Infection: Preliminary Study

Background Methicillin-resistant Staphylococcus aureus (MRSA) has become a one of the most important causes of nosocomial infections, and use of vancomycin for the treatment of MRSA infection has increased. Unfortunately, vancomycin-resistant enterococcus have been reported, as well as vancomycin-resistant S. aureus. Arbekacin is an antibacterial agent and belongs to the aminoglycoside family of antibiotics. It was introduced to treat MRSA infection. We studied the clinical and bacteriological efficacy and safety of arbekacin compared to vancomycin in the treatment of infections caused by MRSA. Materials and Methods This was a retrospective case-control study of patients who were admitted to tertiary Hospital from January 1st, 2009 to December 31st, 2010, and received the antibiotics arbekacin or vancomycin. All the skin and soft tissue MRSA infected patients who received arbekacin or vancomycin were enrolled during the study period. The bacteriological efficacy response (BER) was classified with improved and failure. The improved BER was defined as no growth of MRSA, where failure was defined as growth of MRSA, culture at the end of therapy or during treatment. Clinical efficacy response (CER) was classified as improved and failure. Improved CER was defined as resolution or reduction of the majority of signs and symptoms related to the original infection. Failure was defined as no resolution and no reduction of majority of the signs and symptoms, or worsening of one or more signs and symptoms, or new symptoms or signs associated with the original infection or a new infection. Results Totally, 122 patients (63/99 in arbekacin, 59/168 in vancomycin group) with skin and soft tissue infection who recieved arbekacin or vancomcyin at least 4 days were enrolled and analysed. The bacteriological efficacy response [improved, arbekacin vs vancomycin; 73.0% (46/63), 95% confidence interval (CI) 60.3 to 83.4% vs 83.1% (49/59), 95% CI 71.0 to 91.6%] and clinical efficacy response [improved, arbekacin vs vancomycin; 67.2% (41/61), 95% CI 52.0 to 76.7% vs 78.0% (46/59), 95% CI 65.3 to 87.7%] were similar between the two groups (P=0.264, 0.265). The complication rate was significantly higher in the vancomycin group [29/59(49.2%), 95% CI 35.9 to 62.5%] than arbekacin [10/63(15.9%), 95% CI 8.4 to 29.0%] (P<0.001). Conclusions Arbekacin could be considered as an alternative antibiotics for vancomycin in skin and soft tissue infection with MRSA. However, further prospective randomized trials are needed to confirm this finding.

Time-Dependent Sensitivity of a Rapid Antigen Test in Patients with 2009 H1N1 Influenza

Rapid antigen tests (RAT) are used to screen patients with suspected influenza virus infection and provide results in a timely manner. RAT can also help to reduce unnecessary diagnostic testing, to facilitate antiviral treatment, and to decrease inappropriate use of antibiotics (4). However, the clinical sensitivity of RAT was poor for 2009 H1N1 influenza virus, showing an accuracy from 11.1% to 51% (2‐5). Drexler et al. have suggested that the viral concentrations in clinical samples influence the outcome of RAT (2). Thus, the collection time of the samples may be an important factor for the accuracy of RAT. Retrospectively, we tested 637 clinical samples from 637 different patients. Samples were collected during the pandemic 2009 H1N1 influenza season by nasopharyngeal swab and were kept frozen at 80°C until use. The 120 controls were taken from H1N1-negative febrile subjects. The 2009 H1N1 influenza virus was confirmed by real-time reverse transcription-PCR. A standard curve of control RNA transcripts was constructed in parallel with the detection of viral M segment RNA in clinical samples. Using this standard curve, we calculated the log 10 viral copy number from the cycle threshold (C T). The cutoff value of CT was set at 37 for H1N1 influenza diagnosis. All processes were conducted by following the Centers for Disease Control protocol for H1N1. The RAT was done by using the SD Bioline influenza A/B/A(H1N1) pandemic test kit (Standard Diagnostics, Yongin, South Korea). The RAT has four lines, for the detection of 2009 H1N1, influenza A, influenza B, and controls, and distinguishes between seasonal influenza virus and 2009 H1N1 influenza virus (1). Samples were classified when they were collected by the number of hours elapsed after the first symptoms appeared. They were classified into 24 h (D1), 24 to 48 h (D2), 48 to 72 h (D3), 72 to 96 h (D4), and 96 to 168 h (D5). We calculated the sensitivity and specificity of the RAT. Data analysis was performed using SPSS, version 16.0. The analysis of variance (ANOVA) test and Tukey’s post hoc test were used to compare the mean log 10 viral copy numbers. The study protocol was approved by the Institutional Review Board of the Chonbuk National University Hospital. The mean age of the subjects was 23.4 12.81 (median, 18.0; range, 13 to 82; male, 51.0%). The control patients had a mean age of 34.6 20.8 (median, 27.0; range, 8 to 82; male, 54.3%). The overall sensitivity and specificity of the RAT were 75.6% and 99.3%, respectively. The sensitivity of the RAT at D1, D2, D3, D4, and D5 was 75.0%, 76.8%, 79.9%, 77.4%, and 67.3%, respectively (Fig. 1). The log quantity of virus copy numbers at D1, D2, D3, D4, and D5 was 3.35, 3.60, 3.68, 3.46, and 3.17, respectively (P 0.025). Only D3 and D5 showed a significant difference by Tukey’s post hoc test (P 0.026). The log 10 virus copy number was increased until D3 and then decreased. The RAT is known as a point-of-care test because it can provide results within 30 min or less in every facility. However, the poor sensitivity of the RAT for H1N1 virus was a major problem. In this study, our results revealed that the most appropriate time frame of sample collection for the detection of influenza virus with RAT was 48 to 72 h after the first clinical symptoms appeared. The sensitivity value of RAT in our study was similar to the values reported by Choi et al. (1), but it was higher than those reported by others (2‐5). Our results may help to raise the sensitivity of RAT to be used during the influenza seasons.

Protection against Vibrio vulnificus infection by active and passive immunization with the C-terminal region of the RtxA1/MARTXVv protein

Vibrio vulnificus is a foodborne pathogen that is prevalent in coastal waters worldwide. Infection with V. vulnificus causes septicemia with fatality rates exceeding 50% even with aggressive antibiotic therapy. Several vaccine studies to prevent V. vulnificus infection have been performed but have had limited success. In this study, we identified the C-terminal region (amino acids 3491 to 4701) of the V. vulnificus multifunctional autoprocessing RTX (MARTXVv or RtxA1) protein, RtxA1-C, as a promising antigen that induces protective immune responses against V. vulnificus. Vaccination of mice with recombinant RtxA1-C protein with adjuvant elicited a robust antibody response and a dramatic reduction in blood bacterial load in mice infected intraperitoneally. Vaccination resulted in significant protection against lethal challenge with V. vulnificus. Furthermore, intraperitoneal passive immunization with serum raised against the recombinant RtxA1-C protein demonstrated marked efficacy in both prophylaxis and therapy. These results suggest that active and passive immunization against the C-terminal region of the RtxA1 protein may be an effective approach in the prevention and therapy of V. vulnificus infections.

A placebo-controlled trial of Korean red ginseng extract for preventing Influenza-like illness in healthy adults

AbstractsBackgroundStandardized Korean red ginseng extract has become the best-selling influenza-like illness (ILI) remedy in Korea, yet much controversy regarding the efficacy of the Korean red ginseng (KRG) in reducing ILI incidence remains. The aim of the study is to assess the efficacy of the KRG extract on the ILI incidence in healthy adults.Methods/DesignWe will conduct a randomized, double-blind, placebo-controlled study at the onset of the influenza seasons. A total of 100 subjects 30-70 years of age will be recruited from the general populations. The subjects will be instructed to take 9 capsules per day of either the KRG extract or a placebo for a period of 3 months. The primary outcome measure is to assess the frequency of ILI onset in participated subjects. Secondary variable measures will be included severity and duration of ILI symptoms. The ILI symptoms will be scored by subjects using a 4-point scale.DiscussionThis study is a randomized placebo controlled trial to evaluate the efficacy of the KRG extract compared to placebo and will be provided valuable new information about the clinical and physiological effects of the KRG extract on reduction of ILI incidence including flu and upper respiratory tract infections. The study has been pragmatically designed to ensure that the study findings can be implemented into clinical practice if KRG extract can be shown to be an effective reduction strategy in ILI incidence.Trial RegistrationNCT01478009.

REGULATION OF HUMAN B CELL PROLIFERATION AND DIFFERENTIATION BY SEMINAL PLASMA

To investigate the role of seminal plasma in human B cell functions, its effect on the proliferation and antibody secretion of tonsillar B cells and an Epstein ‐Barr virus (EBV) transformed human B cell line, A4, was examined. Seminal plasma inhibited both the proliferation and differentiation of normal B cells only when added to the cultures at the early period of culture. If addition of seminal plasma was delayed beyond 5 to 6 days, it failed to inhibit IgG secretion. Seminal plasma did not show any inhibitory effect on A4 cells, but rather enhanced both the proliferation and IgG secretion of this B cell line. When the low and high mol. wt fractions of seminal plasma were tested for their biological effects on normal and transformed B cells, the low mol. wt fraction (less than 1 kD) was associated with the inhibitory effect of seminal plasma on normal B cells, whereas high mol. wt fractions (both dialysed and 1500‐kD fraction) was involved in the enhancing effect on A4 cells. We conclude that (i) seminal plasma inhibits the early proliferation of normal human B cells, but does not inhibit the antibody‐secreting capacity of mature B cells; and (ii) different molecules of seminal plasma act on the different stages of B cell maturation.