• Title/Summary/Keyword: Group B streptococcus

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Immunogenicity and safety of a 12-valent pneumococcal conjugate vaccine in infants aged 6-10 weeks: a randomized double-blind active-controlled trial

  • Shin, Jonghoon;Teeratakulpisarn, Jamaree;Puthanakit, Thanyawee;Theerawit, Tuangtip;Ryu, Ji Hwa;Shin, Jinhwan;Lee, Seulgi;Lee, Hayoung;An, Kyungjun;Kim, Hun
    • Clinical and Experimental Pediatrics
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    • v.63 no.7
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    • pp.265-271
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    • 2020
  • Background: Pneumococcal diseases among children aged <5 years worldwide are associated with high annual mortality rates. Purpose: This study aimed to evaluate the immunogenicity and safety of GBP411, a 12-valent pneumococcal conjugant vaccine, with a dosing schedule of 2 primary doses plus 1 booster dose (2p+1) in healthy infants. Methods: This randomized active-controlled (Prevnar 13) double-blind phase 2 trial enrolled healthy subjects aged 6-10 weeks. Three serum concentrations of pneumococcal serotype-specific immunoglobulin G (IgG) were evaluated using the pneumococcal serotype-specific pneumonia polysaccharide enzyme-linked immunosorbent assay at 1 month after the primary doses and before and 1 month after the booster dose. The pneumococcal serotype-specific IgG titer was evaluated using a multiplex opsonophagocytic assay in a subset of 15 subjects per group. Results: After administration of the primary doses, the proportion of subjects who achieved pneumococcal serotype-specific IgG concentrations of >0.35 ㎍/mL was lower for some serotypes in the GBP411 group than in the comparator group (6B: 20.83% vs. 39.22%, P=0.047 and 19A: 58.33% vs. 90.20%, P<0.001). However, after administration of the booster dose, >97% of the subjects in each group achieved IgG concentrations of ≥0.35 ㎍/mL for all 12 serotypes. Increased immunogenicity was observed for some serotypes that showed significant intergroup differences after administration of the primary doses but not after the booster dose. We also found no significant intergroup difference in the overall incidence of solicited local adverse events. Furthermore, the overall incidence of solicited systemic adverse events was significantly lower in the GBP411 group than in the comparator vaccine group (79.59% vs. 98.04%; P=0.003). Conclusion: The GBP411 vaccine with a dosing schedule of 2p+1 may be immunogenic and safe for healthy infants.

Clinical Study of Group B β-Hemolytic Streptococcal Meningitis (B군 연쇄상구균 뇌막염에 대한 임상적 고찰)

  • Lee, Seo-Young;You, Sou-Jeong;Kim, Deok-Soo;Ko, Tae-Sung
    • Clinical and Experimental Pediatrics
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    • v.46 no.12
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    • pp.1224-1229
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    • 2003
  • Purpose : Bacterial meningitis is a serious disease, especially in the neonatal period, and it carries a significant degree of mortality and morbidity. Group B streptococcus(GBS) is a common cause of neonatal bacterial meningitis. The purpose of this study was to evaluate the clinical manifestations, treatment results and complications of GBS meningitis. Methods : We analyzed 29 cases retrospectively who had been admitted to the pediatric ward or NICU in Asan Medical Center from May 1990 to January 2002. They had proven GBS in culture or latex agglutination test in CSF. Results : The male to female ratio was 1 : 1.9. There were two cases of early onset type and 27 cases of late onset type. All cases had normal birth weight with full term at delivery. The perinatal predisposing factors were premature rupture of membrane(two cases), and maternal colonization(two cases). The most common presenting symptoms were fever and irritability. Associated diseases were GBS sepsis(21 cases). There was relatively high sensitivity to penicillin derivatives. There were abnormal brain CT or MRI findings in 16 cases(64%), such as infarction, encephalomalatic change, effusion, hydrocephalus, hemorrhage and abscess. The intensive care unit admission rate and the incidence of DIC were higher in the group with complications. Two cases were discharged against advice. Conclusion : We recommend early detection and active treatment in Group B streptococcal meningitis to improve the prognosis.

Upregulated expression of the cDNA fragment possibly related to the virulence of Acanthamoeba culbertsoni

  • Im, Kyung-Il;Park, Kwang-Min;Yong, Tai-Soon;Hong, Yong-Pyo;Kim, Tae-Eun
    • Parasites, Hosts and Diseases
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    • v.37 no.4
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    • pp.257-263
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    • 1999
  • Identification of the genes responsible for the recovery of virulence in brain-passaged Acanthamoeba culbertsoni was attempted via mRNA differential display polymerase chain reaction (mRNA DD-PCR) analysis. In order to identify the regulatory changes in transcription of the virulence related genes by the brain passages, mRNA DD-PCR was performed which enabled the display of differentially transcribed mRNAs after the brain passages. Through mRNA DD-PCR analysis. 96 brain-passaged amoeba specific amplicons were observed and were screened to identify the amplicons that failed to amplify in the non-brain-passaged amoeba mRNAs. Out of the 96 brain-passaged amoeba specific amplicons, 12 turned out to be amplified only from the brain-passaged amoeba mRNAs by DNA slot blot hybridization. The clone, A289C, amplified with an arbitrary primer of UBC #289 and the oligo dT$_{11}$-C primer, revealed the highest homology (49.8%) to the amino acid sequences of UPD-galactose lipid transferase of Erwinia amylovora, which is known to act as an important virulence factor. The deduced amino acid sequences of an insert DNA in clone A289C were also revealed to be similar to cpsD, which is the essential gene for the expression of type III capsule in group B streptococcus. Upregulated expression of clone A289C was verified by RNA slot blot hybridization. Similar hydrophobicity values were also observed between A289C (at residues 47-66) and the AmsG gene of E. amylovora (at residues 286-305: transmembrane domains). This result suggested that the insert of clone A289C might play the same function as galactosyl transferase controlled by the AmsG gene in E. amylovora.a.

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Clinical features and prognostic factors of early-onset sepsis: a 7.5-year experience in one neonatal intensive care unit

  • Kim, Se Jin;Kim, Ga Eun;Park, Jae Hyun;Lee, Sang Lak;Kim, Chun Soo
    • Clinical and Experimental Pediatrics
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    • v.62 no.1
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    • pp.36-41
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    • 2019
  • Purpose: In this study, we investigated the clinical features and prognostic factors of early-onset sepsis (EOS) in neonatal intensive care unit (NICU) patients. Methods: A retrospective analysis was conducted on medical records from January 2010 to June 2017 (7.5 years) of a university hospital NICU. Results: There were 45 cases of EOS (1.2%) in 3,862 infants. The most common pathogen responsible for EOS was group B Streptococcus (GBS), implicated in 10 cases (22.2%), followed by Escherichia coli, implicated in 9 cases (20%). The frequency of gram-positive sepsis was higher in term than in preterm infants, whereas the rate of gram-negative infection was higher in preterm than in term infants (P<0.05). The overall mortality was 37.8% (17 of 45), and 47% of deaths occurred within the first 3 days of infection. There were significant differences in terms of gestational age (26.8 weeks vs. 35.1 weeks) and birth weight (957 g vs. 2,520 g) between the death and survival groups. After adjustments based on the difference in gestational age and birth weight between the 2 groups, gram-negative pathogens (odds ratio [OR], 42; 95% confidence interval [CI], 1.4-1,281.8) and some clinical findings, such as neutropenia (OR, 46; 95% CI, 1.3-1,628.7) and decreased activity (OR, 34; 95% CI, 1.8-633.4), were found to be associated with fatality. Conclusion: The common pathogens found to be responsible for EOS in NICU patients are GBS and E. coli. Gram-negative bacterial infections, decreased activity in the early phase of infection, and neutropenia were associated with poor outcomes.

Treatment and Prognosis according to Causative Organisms in Neonatal Bacterial Meningitis (신생아 세균성 뇌막염의 원인균에 따른 치료와 예후)

  • Kim, Dong Joon;Lee, Gwang Hoon;Lee, Hyung Won;Kim, Gil Hyun;Lee, Hak Soo
    • Pediatric Infection and Vaccine
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    • v.4 no.1
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    • pp.79-89
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    • 1997
  • Purpose : Neonatal bacterial meningitis is the disease which clinical manifestations are nonspecific and several neurologic complications may occur. We studied neonatal bacterial meningitis, particularly in treatment and prognosis according to causative organisms -gram positive and gram negative bacteria- to assist in treatment of neonatal bacterial meningitis. Methods : We analysed twenty-four cases retrospectively who had been admitted in NICU or pediatric ward in Chung-ang Gil hospital from Jan. 1991 to Jun. 1996, and who had proven causative organisms in culture or latex agglutination[n test in CSF. Results : 1) The ratio of male to female was 2.4: 1. The mean birth weight and gestational age in cases with gram positive bacterial meningitis were $2.91{\pm}0.79kg$ and $38.4{\pm}2.74$ weeks and those in cases with yam negative bacterial meningitis were $3.30{\pm}0.90kg$ and $37.7{\pm}3.33$weeks respectively. There was no significant difference between the two groups. 2) The perinatal predisposing factors were pematurity, mecoinium staining amnionic fluid, matemal diabetes and pregnancy-induced hypertension, etc. The clinical manifestations Were fever, seizure, poor oral intake and fontanel bulging, etc. There were eleven cases with early onset bacterial meningitis(four cases by gram positive bacteria, seven cases by gram negative bacteria), and thirteen cases with late onset bacterial meningitis(seven cases by gram positive bacteria, six cases by gram negative bacteria). There was no significant difference between the two groups in terms of onset. 3) There were eleven cases with yam positive bacterial meningitis and they were coagulase-negative staphylococci(three cases), group B streptococci(three cases), Staphylococcus aureus(two cases), Streptococcus viridans(two cases), and enterococci(one case). And there were thirteen cases with gram negative bacterial menir gitis and they were Escherichia coli(seven cases), Klevsiella pneumoniae(three cases), Pseudomonas aeruginosa(one case), Acinetobactor(one case) and Enterobacter(one case). 4) The initial CSF WBC counts in cases with yam negative bacterial meningitis were significantly higher than those in cases with gram positive bacterial meningitis but the CSF protein and glucose levels were no significant difference in the two groups statistically. 5) The number of cases with abnormal findings in brain ultrasonography was seven in gram positive bacterial meningitis and ten in gram negative bacterial meningitis. 6) There were relatively high sensitivity to penicillin derivatives, the first generation cephalosporin and vancomycin in gram positive bacteria and to the third generation cephalosporin and amikacin in gram negative bacteria. 7) The mortality rate was 20.8%(5 cases were expired or discharged hopelessly). There was no significant difference between the two groups in prognosis. Conclusions : We recommend active treatment in noenatal bacterial meningitis to improve prognosis because the prognosis is poor.

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Trends of Antimicrobial Susceptibility Test for Bacterias Isolated from Blood, Urine, Stool, and Cerebrospinal Fluid(1997~2001) (혈액 및 일반 세균배양에서 검출된 균종과 항균제 감수성 추이(1997~2001))

  • Hong, Mi Ae;Oh, Kyung Chang;Ahn, Seng In;Kim, Bong Rim;Kim, Yun Ho;Kim, Sung Seop;Chang, Jin Keun;Jeun, Kyoung So;Cha, Sung Ho
    • Pediatric Infection and Vaccine
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    • v.10 no.2
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    • pp.167-177
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    • 2003
  • Purpose : To know the trends of antimicrobial susceptibility is critical for antimicrobial treatment. We studied the organisms isolated from blood, urine, stool, and cerebrospinal fluid from 1997 to 2001 to reveal the trends of their antimicrobial susceptibility. Methods : We conducted a retrospective study with isolates obtained from 0~18 year old outpatients and inpatients from 1997 to 2001 at Department of Pediatrics, Hanil general hospital. We gathered the data through the laboratory test files and the origin of microorganisms cultured from blood, urine, stool and cerebrospinal fluid and their antimicrobial susceptibility. Results : Microorganisms were isolated from 226(3.3%) out of 6,974 blood cultures, 365 (8.0%) out of 4,549 urine cultures, 50(1.9%) out of 2,593 stool cultures and 9(1.4%) in 655 cerebrospinal fluid cultures. The most frequently isolated organisms from blood cultures was Staphylococcus epidermidis(33.5%) which was followed by Staphylococcus aureus(19.7%), Escherichia coli(13.8%), and Burkholderia cepacia(9.0%). Among the urine cultures, E. coli was the most common(74.7%) which was followed by Group D Enterococcus(11.3%), Klebsiella pneumoniae(7.1%) and Proteus mirabilis(2.5%). The positive stool cultures all yield Salmonella species. Group D Salmonella was obtained most frequently. Among the positive cerebrospinal fluid cultures, Group B Streptococcus was isolated most frequently. Among the 40 cases of S. aureus in blood cultures, 27 cases were methicillin-resistant. The rates of susceptibility for amikacin, ceftizoxime and ceftriaxone of E. coli isolated from blood cultures were 80%, 100% and 60% in 1997 and 60%, 80% and 60% in 2001. The rates of susceptibility for amikacin, ceftizoxime and ceftriaxone of K. pnumoniae isolated from urine cultures. were 80%, 100% and 80% in 1997 and 50%, 83% and 50% in 2001 Enterococcus was isolated from 6.7% to 15.8% and vancomycin-resistant Enterococcus was observed in 17% of Group D Enterococcus isolated from urine cultures. The rates of susceptibility for amikacin, ceftizoxime and ceftriaxone of Group D Salmonella were 96%, 96% and 92% during the study period. Conclusion : Among the blood cultures S. epidermidis, S. aureus, E. coli and B. cepacia were isolated in order of frequency and among the urine cultures E. coli, Group D Enterococcus, K. pneumoniae and P. mirabilis were isolated in order of frequency. During the study period there was no big difference in major organisms isolated from blood and urine. The methicillin-resistant S. aureus was observed in 67% of S. aureus isolated from blood cultures but vancomycin-reistant S. aureus or vancomycin intermediate resistant S. aureus was not observed. The rates of susceptibility to amikacin and the third generation cephalosporin of E. coli isolated from blood cultures and K. pneumoniae from urine cultures have decreased. The isolation rates of Group D Enterococcus and vancomycin resistant Enterococcus have increased.

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Chemical and Bacteriological Water Qualify of the Sonakdong River (서낙동강 강수의 화학적${\cdot}$세균학적 수질)

  • KIM Yong Gwan
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.19 no.4
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    • pp.347-355
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    • 1986
  • The Sonakdong river is very important water source not only for agricultural water of Kimhae field but also for fishery water. Recently the middle and lower areas of the river have the tendency to be heavily contaminated by domestic sewage and agricultural chemicals. Fifty six water samples were collected from 8 stations from July to December in 1985 for the experiment (Fig. 1). To evaluate the water quality, pH, water temperature, electrical conductivity, chloride ion, nutrients ($NO^{-}_{2}-N,\;NO^{-}_{3}-N,\;NH^{+}_{4}-N,\;PO^{3-}_{4}-P,\;SiO_2-Si$), total coliform, fecal coliform, and fecal streptococcus were determined. Range and mean value of the samples were as follows; pH $6.3{\sim}9.4$, 7.91; water temperature $6.1{\sim}34.8^{\circ}C,\;23.88^{\circ}C$; electrical conductivity (from St. A to G) $1.575{\times}10^2{\sim}30.50{\times}10^2{\mu}{\mho}/cm,\;6.57{\times}10^2{\mu}{\mho}/cm$; chloride ion $23.5{\sim}14,300mg/l$, 770.0mg/l; nitrite-nitrogen $0.007{\sim}0.110mg/l$, 0.053mg/l; nitrate-nitrogen $0.001{\sim}1.638mg/l$, 0.649 mg/l; ammonia-nitrogen $0.017{\sim}4.200mg/l$, 0.497mg/l; phosphate-phoshorus $0.011{\sim}0.281mg/l$, 0.086mg/l; and silicate-silicious $2.4{\sim}6.5mg/l$, 4.43mg/l. Electrical conductivity and chloride ion of the station F(Chomanpo) were $2.676{\times}10^2{\mu}{\Omega}cm$ and 123.99mg/l which were lower than those of others. Among the analyzed nutrients, silicate-silicious concentration was the highest through all the samples. The bacterial density of the samples ranged $36{\sim}110,000/100ml$ for total coliform, $15{\sim}46,000/100ml$ for fecal coliform and $3.6{\sim}15,000/100ml$ for fecal streptococcus. The range and the mean of the TC/FC ratio were $3.0{\sim}9.6$, 5.51 and those of the FC/FS ratio were $1.1{\sim}9.2$, 6.19, respectively. On the other hand, fecal coliform was not detected in about $78\%$ of the water samples examined. Composition of coliform was $52\%$ Escherichia coli group, $3\%$ Citrobacter freundii group, $13\%$ Enterobacter aerogenes group and $31\%$ others.

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Neonatal Sepsis and Antimicrobial Susceptibilities in the Neonatal Intensive Care Unit and Nursery (신생아 패혈증의 원인 및 항생제 감수성)

  • Moon, Jin Hwa;Oh, Sung Hee;Kim, Hak Won;Moon, Su Jee;Choi, Tae Yeol
    • Pediatric Infection and Vaccine
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    • v.9 no.2
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    • pp.163-174
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    • 2002
  • Background : To delineate the changes in the causative agents of neonatal sepsis and their antimicrobial susceptibilities in the neonatal intensive care unit and nursery of Hanyang University Hospital during the past 10 years. Methods : Hospital records of 15,144 patients hospitalized at the NICU and nursery of Hanyang University Hospital from 1989 to 1998 were reviewed and neonates diagnosed of neonatal sepsis were sorted and included in the study. The study period was divided into Period A(the first 5 years) and Period B(the second 5 years) to analyse causative agents and their antimicrobial susceptibilities. Results : Neonatal sepsis was diagnosed in 170 patients(1.1%{Period A 1.2%, Period B 1.0%}) among the total of 15,144 inpatients. Two hundred isolates(Period A 109 isolates, Period B 91 isolates) were identified in 186 blood cultures(Period A 99 cultures, Period B 87 cultures) from 170 patients(Period A 91 patients, Period B 79 patients). The average age at the onset of the disease, when the initial blood culture was drawn, was 12.3 days old(Period A 8.8 days, Period B 16.3 days), and the proportion of the early onset disease was 34.7% in Period A and 23.0% in Period B, indicating that neonatal sepsis developed earlier during Period A. Among the isolated organisms including Gram positive bacteria[132(66.0%)], Gram negative bacteria [60(30.0%)], and fungi[8(4.0%)], coagulase negative Staphylococcus(CNS) was the most common organism(69/34.5%), followed by Staphylococcus aureus(36/18.0%), Klebsiella pneumoniae(17/8.5%), Enterococcus(12/6.0%), Enterobacter cloacae(8/4.0%), Escherichia coli(6/3.0%), and Pseudomonas aeruginosae(5/2.5%). The isolated fungi were Candida parapsilosis, Candida albicans, and Trichosporon pullulans. CNS, S. aureus and Acinetobacter baumannii were isolated more frequently in Period A compared to Period B. Antimicrobial susceptibilities of CNS and S. aureus to methicillin and the first generation cephalo sporins were decreased in Period B compare to Period A, those to aminoglycosides were increased in Period B, and vancomycin resistant strains were not identified. K. pneumoniae, Enterococcus, E. coli, and P. aeruginosa were isolated less frequently in Period B, compared to Period A. For K. pneumoniae, antimicrobial susceptibilities to the first generation cephalosporins were low in both Periods A and B, those to tobramycin and gentamicin were increased in Period B, and those to amikacin, ceftriaxone, and trimethoprim-sulfamethoxazole were high in both Periods A and B. Antimicrobial susceptibilities of Enterococcous to ampicillin, penicillin, and the first generation cephalosporins were decreased in Period B, but vancomycin resistant strains were not identified. Conclusion : The occurrence rate of neonatal sepsis during the past 10 years in the NICU and nursery of the Hanyang University hospital was 1.1%, and the most common causitive agents were CNS and S. aureus, to which the antimicrobial susceptibilities to the first line drugs decreased in the later half of the study period with no vancomycin resistant isolates identified. Group B Streptococcus known to be the most common agent causing neonatal sepsis was not identified, and K. pneumoniae was isolated more commonly during the later half of the study period without decreased antimicrobial susceptibilities.

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A Short-Term Study of the Effects of UDCA on Gingival Inflammation in the Beagle Dog (우로수데옥시콜릭산이 치주질환 억제에 미치는 영향)

  • Park, Sang-Hyun;Han, Seoung-Min;Choi, Sang-Mook;Ku, Young;Rhyu, In-Chul;Han, Soo-Boo;Lee, Hak-Mo;Kim, Moon-Moo;Kim, Sang-Nyun;Chung, Chong-Pyoung
    • Journal of Periodontal and Implant Science
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    • v.29 no.1
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    • pp.1-14
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    • 1999
  • Ursodeoxycholic acid(UDCA) is a hydrophilic gall bladder acid and has been used as a effective drug for liver disease related to in1munity. This drug inhibits secretions of IL-2, IL-4, and $IFN-{\gamma}$ from T-cells and production of immunoglobulin from B-cells. Also it has been reported that UDCA inhibits production of IL-1 related to the progression of periodontal disease and activation of collagenases. The purpose of the present study was to elucidate the effects of UDCA on inhibition of periodontal disease progression using clinical, microbiological and histometrical parameters. Twelve pure bred, 16 month-old-beagle dogs were used in the study. After ligature-induced periodontal diseases were formed, experimental drugs were applied twice a day and then the results of clinical, microbiological, and histometrical parameters were measured at baselie(initiation of experiment) , 4weeks and 8weeks. The gel with UDCA(concentration 0.5%, 5% 3 dogs in each) was applied to experimental group, chlorhexidine to positive control group(3dogs) and the gel without UDCA(base) to negative control group. After induction of general anesthesia, the maxillary 2nd, 3rd premolars and 1st molar and the mandibular 2nd, 3rd, 4th premolars and 1st molar were ligated in one side selected randomly and were not ligated in the opposite side. The plaque index(PI), gingival index(GI), pocket depth(PD) and gingival crevicular fluid(GCF) volum were measured clinically. The PI and GI were measured at 3 buccal points of all experimental teeth and the GCF was measured only at the 3rd premolar in the maxilla and the 4th premolar in the mandible. In the microbiological study, the samples extracted from the 3rd premolar of the maxilla and the 4th premolar of the mandible at the center of buccal surface were analyzed aerobics, anaerobics and Streptococcus colony forming units, After clinical and microbiological examination at 8weeks, the dogs were sacrificed by carotid artery perfusion. The samples were fixed and sectioned including interproximal area, and the distance from cementoenamel junction(CEJ) to alveolar crest was measured. The results were that PI, GI and PD increased until 4 weeks and decreased at 8 weeks in three groups but the differences between all the groups were not significant. The 0.5% UDCA in non-ligated group showed remarkable decrease of GCF. The experimental group applied 5% UDCA decreased the number of aerobics and anaerobics. The distance from CEJ to alveolar crest was greater in the negative control group on both ligated and non-ligated sides, but the differences were not significant stastically.

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Analysis of antibacterial, anti-inflammatory, and skin-whitening effect of Centella asiatica (L.) Urban (병풀의 추출용매에 따른 항균, 항염증 활성 및 피부 미백효능 등의 분석)

  • Goo, Young-Min;Kil, Young Sook;Sin, Seung Mi;Lee, Dong Yeol;Jeong, Won Min;Ko, Keunhee;Yang, Ki jeung;Kim, Yun-Hee;Lee, Shin-Woo
    • Journal of Plant Biotechnology
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    • v.45 no.2
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    • pp.117-124
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    • 2018
  • The imports of Centella asiatica L. Urban are increasing year-by-year due to the fact that its extract is a raw material used for skin wounds and in cosmetics. However, studies on the cultivation and identification of native C. asiatica species in Korea have been extremely rare. Therefore, this study was conducted in order to investigate the physiological and functional activity of Korean native C. asiatica plant cultivated in Hapcheon, Gyeongsangnam-do, Korea. As a result, the highest antibacterial and anti-inflammatory activities were examined with methanol extract while skin-whitening and wrinkle improvement were examined with water extract. Seven bacterium and one fungus were treated with 50% methanol extracts of C. asiatica and most of the bacterium showed similar or low levels of antibacterial activity compared to the control group of Omiza (Schisandra chinensis) extract, except for Streptococcus pyogenes, which showed higher antimicrobial activity than that of Omiza extract. However, neither C. asiatica and Omiza extracts showed antimicrobial activity against the fungus, C. albicans. The results of anti-inflammatory effect analyses with Raw 264.7 cells confirmed that the treatment of methanol extract reduced the level of NO by 50% or more compared to the control group. In addition, the water extract showed the highest reduction of melanin content of up to 20% more than the control group when examined with B16F10 cell line, indicating a significant skin-whitening effect. Furthermore, we were able to show the significant skin wrinkle improvement caused by C. asiatica extract with NHDF cell as an indicator, but strong cytotoxicity was also observed, suggesting that further studies are necessary.