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Incidence of Escherichia coli and Its Susceptibility to Antimicrobials in Childhood Urinary Tract Infection (소아 요로감염에서 Escherichia coli의 빈도와 항생제 감수성에 대한 연구)

  • Chi Hye-Mi;Kwahk Jae-Hyok;Lee Jun-Ho;Park Hye-Won
    • Childhood Kidney Diseases
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    • v.10 no.1
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    • pp.18-26
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    • 2006
  • Purpose : Empirical antimicrobial treatment is indicated before bacteriological results are available for young children with febrile UTI to minimize renal scarring. To ensure appropriate therapy, knowledge of the prevalence of causative organisms and their susceptibility patterns to antimicrobials is mandatory. We performed a retrospective analysis investigating the local prevalence and resistance patterns of uropathogens, primarily E. coli, isolated from community-acquired UTIs. Methods : A total of 103 positive urine cultures from children with febrile UTI collected at Bundang CHA General Hospital from February 2004 to February 2005 were analyzed. Inclusion criteria were fever higher than $37.5^{\circ}C$, significant bacteriuria with single strain growth of at least 10s colony forming units/mL urine, and leukocyturia >5/HPF. Results : E. coli(89.3%) was the leading uropathogen followed by Enterococcus spp.(3.9%) Klebsiella spp.(2.9%), Citrobctcter spp.(1.9%) and Enterobacter spp.(1.9%). E. coli strains revealed a low proportion of antimicrobial susceptibility to ampicillin(AMP; 27.2%) ampicillinsulbactam(AMS; 34.8%) and trimethoprim-sulfamethoxazole(SXT; 65.2%). Susceptibility patterns to cephalosporins were as follows; cefazolin(1st generation; 91.3%), cefoxitin(2nd; 100%), ceftriaxone(3rd; 97.8%) and cefepime(4th; 97.8%). Three E. coli isolates produced ex tended - spectrum beta-lactamase(ESBL). Conclusion : Empirical treatment with AMP, AMS and SXT, which are commonly used in pediatric clinics, is not recommended for childhood UTI due to high incidence of resistance. The high level of susceptibility to cephalosporins makes these drugs reasonable alternatives. However the emergence of ESBL-producers, even though they are quite few, may have an impact on cephalosporin treatment in the future. (J Korean Soc Pediatr Nephrol 2006;10:18-26)

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Guidelines for the Management of Hydronephrosis Detected in the Perinatal Period (주산기에 발견된 수신증의 자연 경과와 치료 방침)

  • Chae Soo-Ho;Lee Ji-Hyuk;Jin Dong-Kyu;Park Kwan-Hyun;Paik Kyung-Hoon
    • Childhood Kidney Diseases
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    • v.10 no.1
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    • pp.33-39
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    • 2006
  • Purpose : Neonatal hydronephrosis is diagnosed with an incidence of 4.5-7% of pregnancies. Recently, early detection of neonatal hydroneprosis with antenatal ultrasonography has be-come possible. But consensus about its management has not been reached, especially concerning surgical intervention. The purpose of this study is to analyze the natural course of neonatal hydronephrosis and to determine the guideline of surgical intervention and follow up study. Methods : Sixty nine hydronephrotic kidneys were confirmed from April 2001 to April 2005. All cases were rechecked by ultrasonography once at least and had a minimum follow-up of 6 months. We classified the patients into 4 groups according to the anterior posterior pelvic diameter(APPD) on perinatal ultrasonography. Ultrasonography to measure the APPD diameter and Society for Fetal Urology(SFU) grade, $^{99m}Tc-MAG3$ scan were done to a set protocol. Pyeloplasty was peformed according to the protocol. Results : Pyeloplasty was not needed in most cases where the APPD was below 10 mm and where the SFU grade were less than grade 3. Many cases with APPD 10 mm above or SFU grade III above had undergone pyeloplasty. We found a correlation between obstruction grade on MAG3 scan and whether surgery was performed or not. Conclusion : If APPD is above 10 mm, SFU grade is above grade 3 or urinary tract obstruction is suspected by MAG3 scan, pyeloplasty must be considered. In cases where APPD is below 10mm and SFU grade is less than grade 3, we can observe the natural course of neonatal hydronephrosis with consecutive follow-up. (J Korean Soc Pediatr Nephrol 2006;10:33-39)

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Incidence of Vesicoureteral Reflux and Renal Scar in Asymptomatic Siblings of Patients with Primary Vesicoureteral Reflux (선천성 방광요관역류 환아의 형제자매에서 방광요관역류와 신반흔의 유병률)

  • Yu Je-Yun;Suck Hyo-Chung;Song Jun-Young;Park Moon-Sung;Kim Young-Soo;Pai Ki-Soo
    • Childhood Kidney Diseases
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    • v.7 no.2
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    • pp.181-188
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    • 2003
  • Purpose : Vesicoureteral reflux(VUR) is known to be the main cause of childhood hypertension and renal failure. Knowing its familial occurrence, we determined the incidence of VUR and renal scar in asymptomatic siblings of Korean patients with primary VUR Methods : A total of 50 siblings from 37 index patients were included. Voiding cystourethro-graphy(VCUG) and renal scintigraphy using $^{99m}Tc-DMSA$ were peformed in these siblings from June, 1994 to May, 2001, Index patients were classified into two groups according to the presence of VUR in their siblings, and the clinical factors of the index patients such as age, sex, grade of reflux and renal cortical defect were compared between the groups. Results : Among the 50 siblings, VUR were found in 8(16%) and renal cortical defects were detected in 8(16%) siblings respectively. The incidence of renal cortical defects was 87.5%(7 out of 8) in the VUR(+) siblings. There was a case of VUR(-) cortical defect in one sibling, presumed as a scar from an old VUR. There was no relationship among age, sex, grade of reflux and renal cortical defect of the index patient to the presence of VUR in siblings. Conclusion : This study confirmed a significant incidence of VUR(16%) and renal cortical defects(16%) in the asymptomatic siblings of patients with primary VUR in Korea. It Is resonable to recommend screening studies to the siblings of patients with VUR for the early detection and prevention of probable reflux nephropathy. (J K orean Soc Pediatr Nephrol 2003;7:181-188)

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Clinical Comparison of $Henoch-Sch\"{o}nlein$ Purpura Nephritis in Children and Adults (소아와 성인 $Henoch-Sch\"{o}nlein$ Purpura(HSP) 신염의 임상적 비교)

  • Kim Ki-Eun;Shin Youn-Ho;Shin Jae-Il;Park Jee-Min;Jeong Hyeon-Joo;Lee Jae-Seung
    • Childhood Kidney Diseases
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    • v.7 no.2
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    • pp.157-165
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    • 2003
  • Purpose : $Henoch-Sch\"{o}nlein$ purpura(HSP) is a systemic vasculitis that involves multiple organs, especially the kidney, which is the most important organ in determining the prognosis of the disease. The morbidity of HSP nephritis in adults is low and there have been little research done on its clinical course so far. Therefore, we have compared the clinical course of HSP nephritis in children and adults in Korea. Methods : We retrospectively analyzed 81 cases of HSP nephritis in children younger than 15 years of age, and 25 cases of adults older than 15 years of age who were admitted to Yonsei University Medical College Severance Hospital from Jan. 1986 to May 2003. Results : The male to female ratio was 1.5 : 1 in children and 1.3 : 1 in adults. The incidence of HSP nephritis for both age groups was found to be increased during the autumn and winter. Infection was the predisposing factor in 39 cases(48.1%) of children, 16 cases(64.0%) of adults, and drugs were the predisposing factor in 8 cases(9.9%) of children and 4 cases (16.0%) of adults. All patients initially presented with microscopic hematuria. Thirteen cases (16.0%) of children and 7 cases(28.0%) of adults initially showed proteinuria of nephrotic range. Thirty four cases(42.0%) of children and 4 cases(16.0%) of adults showed normal urinalysis after treatment. Asymptomatic urinary abnormalities were found in 41 cases(50.6%) of children and 18 cases(72.0%) of adults. Complications such as nephrotic syndrome and hypertension were found in 3 cases(3.7%) of children and 2 cases(8.0%) of adults. Three children(3.7%) and 1(4.0%) adult required dialysis or renal transplantation. Follow-up renal biopsies were performed on 21 children, of whom 10 cases(47.6%) did not show any histologic change, 9 cases(42.9%) showed low grade changes, and 2 cases(9.5%) showed high grade changes. Prognosis was gloomy when proteinuria of nephrotic range and high grade of abnormal histology were present at diagnosis, and there was no significant difference between the two groups(P<0.05) Conclusion : This study showed that there was no difference in terms of the clinical features and courses between the children and adults with HSP nephritis. Proteinuria of nephrotic range and the severity of abnormal histologic changes at diagnosis were found to be associated with a bad prognosis, therefore we recommend that patients with these features require long term follow-up and management.

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A Clinicopathological Study of Idiopathic Membranous Nephropathy in Children (소아에서 일차성 막성 신병증의 임상-병리학적 고찰)

  • Lee Bum-Hee;Cho Hee-Yeon;Kang Ju-Hyung;Kang Hee-Gyung;Ha Il-Soo;Cheong Hae-Il;Lee Hyun-Soon;Choi Yong
    • Childhood Kidney Diseases
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    • v.7 no.2
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    • pp.133-141
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    • 2003
  • Purpose : Idiopathic Membranous Nephropathy(IMN) is a rare renal disease in children. To help better understanding of its clinical course and treatment strategies, we reviewed the clinical manifestations and pathological findings of children with IMN. Methods : Among 58 cases with MN, from 1977 to 2003, 42(72.4%) were hepatitis B virus (HBV) associated and 16(27.6%), 6 males and 10 females, were idiopathic. All cases diagnosed aster 2000 were IMN. Several clinicopathological findings(sex, onset age, proteinuria, serum albumin, cholesterol, creatinine clearance, tubulointerstitial changes, glomerular sclerosis, hypertension, renal vein thrombosis, the use of ACE inhibitor, and immunosuppressive therapy) were compared between the remission and the non-remission group of the patients with IMN. Results : The median onset age was 13.4 years. Clinical manifestations were nephrotic syn-drome(7 cases, 43.8%), gross hematuria(5 cases, 31.3%) and microscopic hematuria with proteinuria(3 cases, 18.8%). Hypertension, hypocalcemic tetany and renal vein thrombosis were accompanied in 2, 1 and 2 cases, respectively. In addition to the typical findings of MN, the kidney biopsies showed segmental sclerosis(5 cases, 31.3%) or global sclerosis(6 cases, 37.5 %), diffuse crescents(1 case), and mild(11 cases, 68.7%) or moderate tubulointerstitial changes(3 cases, 18.8%). Thirteen cases(86.7%) received oral steroid. Among them 2 cases received cyclophophamide and 1 received cyclosporin as well. Ten cases(62.5%) received ACE inhibitors. In the patients followed up, 7 cases(46.7%) became free from proteinuria (remission group) while 8(53.3%) presented continous proteinuria (non-remission group), two (13.3%) of which progressed to renal failure. Clinicopathological findings showed no significant differences between the two groups. Conclusion : With HBV vaccination, HBV associated MN decreased markedly and IMN has taken up most of MN in children. For better understanding of this rare disease, a prospective multicenter study of the clinical course and treatment strategies should be done.

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7-Ketocholesterol Induces Vascular Smooth Muscle Cell Apoptosis via Akt Degradation (7-Ketocholesterol에 의한 Akt 감소와 혈관평활근세포의 세포자멸사)

  • Seo, Kyo Won;Kim, Chi Dae;Lee, Won Suk
    • Journal of Life Science
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    • v.26 no.2
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    • pp.226-233
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    • 2016
  • Vascular smooth muscle cell (VSMC) apoptosis has been identified in various vascular diseases, including atherosclerosis and restenosis after angioplasty, and has been known to precipitate atherosclerotic plaque instability and rupture. Oxysterols are known as inducers of apoptosis in VSMC, and 7-ketocholesterol (7KC) is the major nonenzymically formed oxysterol in atherosclerotic lesions. The precise mechanism underlying VSMC apoptosis is still poorly understood. In this study, we investigated whether 7KC causes apoptosis, and characterized its apoptotic mechanisms in primary cultured rat aortic VSMC. Cell viability was assessed by MTT assay and trypan blue assay. Apoptosis was assessed by flow cytometry, immunofluorescence, immunoprecipitation, and Western blot analyses. 7KC markedly decreased the VSMC viability in a time- and concentration-dependent manner, and increased the production of 4-hydroxynonenal (HNE), a major end-product of lipid peroxidation, which also decreased the VSMC viability. Pretreatment with 2,4-dinitrophenylhydrazine, a well-known reagent of lipid peroxidation-derived aldehydes, significantly restored the 7KC-decreased viability of VSMC. Furthermore, HNE, as well as 7KC, reduced the level of total Akt, a major mediator of cell survival. The 7KC-decreased level of total Akt was significantly restored by pretreatments with 2,4-dinitrophenylhydrazine and N-acetylcysteine. Lactacystin, a proteasome inhibitor, protected VSMC against apoptosis and Akt degradation, but did not inhibit HNE production. In the immunoprecipitation assay, 7KC increased HNE-modified Akt. From the results, it seems that, in atherosclerotic lesions, 7KC induces HNE production in VSMC, and this HNE binds to Akt, proceeding to proteasomal degradation of Akt, through which mechanism the atherosclerotic plaque instability may be facilitated.

Apoptotic Effect of Extract from Artemisia annua Linné by Akt/mTOR/GSK-3β Signal Pathway in Hep3B Human Hepatoma Cells (Hep3B 간암세포에서 개똥쑥추출물로부터 Akt-mTOR-GSK3β 신호경로에 의한 apoptosis 효과)

  • Kim, Eun Ji;Kim, Guen Tae;Kim, Bo Min;Lim, Eun Gyeong;Ha, Sung Ho;Kim, Sang-Yong;Kim, Young Min
    • Journal of Life Science
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    • v.26 no.7
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    • pp.764-771
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    • 2016
  • Extracts from Artemisia annua Linné (AAE) have been known to possess various functions, including anti-bacterial, anti-virus, and anti-oxidant effects. However, the mechanism of those effects of AAE is not well-known. The aim of this study was to analyze the inhibitory effects of AAE on cell proliferation of the human hepatoma cell line (Hep3B) and to examine its effects on apoptosis. Activation by phosphorylation of Akt is cell proliferation through the phosphorylation of TSC2, mTOR, and GSK-3β. We suggested that AAE may exert cancer cell apoptosis through Akt/mTOR/GSK-3β signal pathways and mitochondria-mediated apoptotic proteins. For this, we examined the effects of extracts of AAE on cell proliferation according to treatment concentration. Treatment with AAE not only reduced cell viability, but also resulted in the induced release of lactate dehydrogenase (LDH). These results were determined with a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and a lactate dehydrogenase (LDH) assay. Furthermore, we determined the effects of apoptosis through Hoechst 33342 staining, annexinⅤ-propidium iodide (PI) staining, 5,5′, 6,6′-tetrachloro-1,1′,3,3′-tetraethyl-imidacarbocyanine iodide (JC-1) staining, and Western blotting. Our study showed that the treatment of liver cancer cells with AAE resulted in the inhibition of Akt, TSC2, GSK-3β-phosphorylated, Bcl-2, and pro-caspase 3 and the activation of Bim, Bax, Bak, and cleaved PARP expressions. These results indicate that AAE induced apoptosis by means of a mitochondrial event through the regulate of Akt/mTOR/GSK-3β signaling pathways.

Effects of Non-ionic Surfactant Tween 80 on the in vitro Gas Production, Dry Matter Digestibility, Enzyme Activity and Microbial Growth Rate by Rumen Mixed Microorganisms (비이온성 계면활성제 Tween 80의 첨가가 반추위 혼합 미생물에 의한 in vitro 가스발생량, 건물소화율, 효소활력 및 미생물 성장율에 미치는 영향)

  • Lee, Shin-Ja;Kim, Wan-Young;Moon, Yea-Hwang;Kim, Hyeon-Shup;Kim, Kyoung-Hoon;Ha, Jong-Kyu;Lee, Sung-Sil
    • Journal of Life Science
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    • v.17 no.12
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    • pp.1660-1668
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    • 2007
  • The non-ionic surfactant (NIS) Tween 80 was evaluated for its ability to influence invitro cumulative gas production, dry matter digestibility, cellulolytic enzyme activities, anaerobic microbial growth rates, and adhesion to substrates by mixed rumen microorganisms on rice straw, alfalfa hay, cellulose filter paper and tall fescue hay. The addition of NIS Tween 80 at a level of 0.05% increased significantly (P<0.05) in vitro DM digestibility, cumulative gas production, microbial growth rate and cellulolytic enzyme activity from all of substrates used in this study. In vitro cumulative gas production from the NIS-treated substrates; rice straw, alfalfa hay, filter paper and tall fescue hay was significantly (P<0.05) improved by 274.8, 235.2, 231.1 and 719.5% compared with the control, when substrates were incubated for 48 hr in vitro. The addition of 0.05% NIS Tween 80 to cultures growing on alfalfa hay resulted in a significant increase in CMCase (38.1%), xylanase (121.4%), Avicelase (not changed) and amylase (38.2%) activities after 36 h incubation. These results indicated that the addition of 0.05% Tween 80 could greatly stimulate the release of some kinds of cellulolytic enzymes without decreasing cell growth rate in contrast to trends reported with aerobic microorganism. Our SEM observation showed that NIS Tween. 80 did not influence the microbial adhesion to substrates used in the study. Present data clearly show that improved gas production, DM digestibility and cellulolytic enzyme activity by Tween 80 is not due to increased bacterial adhesion on the substrates.

Expression of Yippee-Like 5 (YPEL5) Gene During Activation of Human Peripheral T Lymphocytes by Immobilized Anti-CD3 (인체 말초혈액의 활성화 과정 중 yippee-like 5 (YPEL5) 유전자의 발현 양상)

  • Jun, Do-Youn;Park, Hye-Won;Kim, Young-Ho
    • Journal of Life Science
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    • v.17 no.12
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    • pp.1641-1648
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    • 2007
  • Yippee-like proteins, which have been identified as the homolog of Drosophila yippee protein containing a zinc-finger domain, are known to be highly conserved among eukaryotes. However, their functional roles are still poorly understood. Recently we initiated ordered differential display (ODD)-polymerase chain reaction (PCR) to isolate genes of which expressions are altered following activation of human T cells. On the ODD-PCR image, one PCR-product detected in unstimulated T cells was not detectable at the time when the activated T cells traversed near $G_1/S$ boundary following activation by immobilized anti-CD3. Cloning and nucleotide sequence analysis revealed that the PCR-product was yippee-like 5 (YPEL5) gene, which was known as a human homolog of the Drosophila yippee gene. Northern blot analysis confirmed the amount of ${\sim}2.2$ kb YPEL5 mRNA expression detectable in unstimulated T cells was sustained until 1.5 hr after activation and then rapidly declined to undetectable level by 5 hr. Ectopic expression of YPEL5 gene in human cervix epitheloid carcinoma HeLa cells caused a significant reduction in cell proliferation to the level of 47% of the control. Expression of GFP-YPEL5 fusion protein in HeLa cells showed its nuclear localization. These results demonstrated that the expression level of human YPEL5 mRNA was negatively regulated in the early stage of T cell activation, and suggested that YPEL5 might exert an inhibitory effect on the cell proliferation as a nuclear protein.

Comparison of Raw versus Relative scores in the Assessment of Coping Patterns in Chronic Arthritis Patients (만성관절염 환자의 대응양상정도와 관련변수 분석 -원점수와 상대점수를 이용한 비교-)

  • Chun, Chung-Ja;Mun, Mi-Suk
    • Journal of muscle and joint health
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    • v.3 no.1
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    • pp.90-103
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    • 1996
  • The purpose of this paper is to compare two approach to assessment of coping patterns. The sampling method was a purposive sampling technique. The study participants were out patients 113 of rheumatoid arthritis center of one University hospitals in Seoul. Datas were collected from Nov. 13 to Nov. 24, 1995. The instruments used for this study were Graphic Rating Scales of pain, The Beck Depression Inventory and Coping Patterns tool. The collected data were analyzed for frequency, means, SD, factor analysis., Pearsons' correlations and ANOVA. The results were summerized as follows ; 1. When raw scores were used : there were not correlation in all three coping patterns. 2. When relative scores were used : there were significantly correlated in all three coping patterns. 1) Active coping and Positive-cognitive coping (r=-0.352, p< 0.0001) 2) Positive-cognitive coping and Negative-cognitive coping (r=-0.594, p< 0.0001) 3) Active coping and Negative-cognitive coping(r=-0.544, p< 0.0001) The results of this research with relative scales provided more insight into the correlation in all three coping patterns. 3. Pearsons' Correlations were computed for each coping pattern, age, pain level, duration of pain and BDI. 1) Using raw score : (1) Active coping was significantly related to pain level(sensory score ; r=0.268, p<0.05, affective score ; r=0.266, p< 0.05) (2) Positive-cognitive coping was significantly related to age (r=-0.252, p< 0.05), pain level (sensory score ; r= -0.244, p< 0.05) (3) Negative-cognitive coping was significantly related to depression level (r=0.312 p< 0.0001). 2) Using relative score (1) Active coping was significantly related to pain level(sensory score ; r=0.299, p<0.05, affective score ; r=0.246, p< 0.05) (2) Positive-cognitive coping was significantly related to age (r= -0.187, P< 0.05), pain level (sensory score ; r=-0.317, p<0.0001, affective score : r=-0.305, p<0.0001) and depression level(-0.339, p<0.0001)) (3) Negative-cognitive coping was significantly related to depression. level(r=0.313, p<0.0001). 4. When raw and realtive coping scores were compared to those of age groups, religious groups and BDI level(high, middle, low) ; 1) Using raw score : (1) Active coping : there were not significantly difference (2) Positive-cognitive coping ; 20-39 age group and 50-59age group had significantly higher scores than over 60age group. BDI-low level group had significantly higher scores than other groups. (3) Negative-cognitive coping : 20-39age group and over 60age group had significantly higher scores than 40-49age group. Non-religious group had significantly higher scores than christian group. BDI-high level group had significantly higher scores than other groups. 2) Using relative score : (1) Active coping : over 60 age group had significantly higher scores than 20-39 age group and 40-49age group had significantly higher scores than 20-39 age group (2) Positive-cognitive coping ; 40-49age group, 20-39age group and 50-59age group had significantly higher scores than over 60age group. Christian group had significantly higher scores than non-religious group. BDI-low level group had significantly higher scores than other groups. (3) Negative-cognitive coping ; Non-religious group had significantly higher scores than christian group and buddhistic group. BDI-high level group had significantly higher scores than other groups. The current data suggest that relative scores may yield a different perspective on coping patters than raw scores. The use of relative scores reveals the relation clearly, without its being blurred statistically by the effect of other coping strategies or being relegated to a partial correlation. The use of relative scores holds promise for delineating the relations between ways of coping and health-related behavior.

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