Morphologic and genetic identification of Diphyllobothrium nihonkaiense in Korea

Diphyllobothrium nihonkaiense was first described by Yamane in 1986 but the taxonomical features have been obscure due to lack of critical morphologic criteria in its larval and adult stages. In Korea, this tapeworm had long been known as Diphyllobothrium latum. In this study, we observed 62 specimens collected from Korean residents and analyzed them by morphological features and nucleotide sequences of mitochondrial cox1 gene as well as the ITS1 region. Adult tapeworms were examined after carmine or trichrome stain. Longitudinal sections of the gravid proglottids showed an obtuse angle of about 150 degree between the cirrus sac and seminal vesicle. This angle is known as a major differential point compared with that of D. latum. Nucleotide sequence differences between D. latum and the specimens from Koreans represented 17.3% in mitochondrial DNA cox1 gene. Sequence divergence of ITS1 among 4 Korean isolates was 0.3% and similarity was 99.7% with D. nihonkaiense and D. klebanovskii. All of the Korean specimens analyzed in this study were identified as being D. nihonkaiense (n = 62). We propose its Korean name as "Dong-hae-gin-chon-chung" which means 'long tapeworm of the East Sea' for this newly analyzed diphyllobothriid tapeworm in Korea.

Promotion of stem cell proliferation by vegetable peptone

OBJECTIVES

Technical limitations and evolution of therapeutic applications for cell culture-derived products have accelerated elimination of animal-derived constituents from such products to minimize inadvertent introduction of microbial contaminants, such as fungi, bacteria or viruses. The study described here was conducted to investigate the proliferative effect of vegetable peptone on adult stem cells in the absence of serum, and its possible mechanisms of action.

MATERIALS AND METHODS

Cell viability and proliferation were determined using the MTT assay and Click-iT EdU flow cytometry, respectively. In addition, changes in expression of cytokine genes were analysed using MILLIPLEX human cytokine enzyme-linked immunosorbent assay kit.

RESULTS

Viability of cord blood-derived mesenchymal stem cells (CB-MSC) and adipose tissue-derived stem cells (ADSC) increased significantly when treated with the peptone. In addition, median value of the group treated with peptone shifted to the right when compared to the untreated control group. Furthermore, quantitative analysis of the cytokines revealed that production of vascular endothelial growth factor (VEGF), transforming growth factor-beta1 (TGF-beta1), and interleukin-6 (IL-6) increased significantly in response to treatment with our vegetable peptone in both CB-MSCs and ADSCs.

CONCLUSIONS

Our findings revealed that the vegetable peptone promotes proliferation of CB-MSCs and ADSCs. In addition, results of this study suggest that induction of stem cell proliferation by vegetable peptone is likely to be related to its induction of VEGF, TGF-beta1, and IL-6 expression.

A hospital-based serological survey of cryptosporidiosis in the Republic of Korea

The seroprevalence of cryptosporidiosis was examined using patients' sera collected from hospitals located in 4 different areas of the Republic of Korea. ELISA was used to measure antibody titers against Cryptosporidium parvum antigens from a total of 2,394 serum samples, which were collected randomly from patients in local hospitals; 1) Chungbuk National University Hospital, 2) Konkuk University Hospital, 3) local hospitals in Chuncheon, Gangwon-do (province), 4) Jeonnam National University Hospital, from 2002 through 2003. Of the 2,394 samples assayed, 34%, 26%, and 56% were positive for C. parvum-specific IgG, IgM, and IgA antibodies, respectively. Positive IgG titers were most common in sera from Jeonnam National University Hospital, Gwangju, Jeollanam-do, and positive IgM titers were most common in sera from Chungbuk National University Hospital, Cheongju, Chuncheongbuk-do. The seropositivity was positively correlated with age for both the IgG and IgA antibodies but was negatively correlated with age for the IgM antibodies. Western blotting revealed that 92%, 83%, and 77% of sera positive for IgG, IgM, and IgA ELISA reacted with 27-kDa antigens, respectively. These results suggested that infection with Cryptosporidium in hospital patients occurs more commonly than previously reported in the Republic of Korea.

Application of computerized adaptive testing in medical education

Application of computerized adaptive testing (CAT) in medical education is still spare in the high stakes examination or in the school-based examination. In the medical school in Belgium, CAT was used for an assessment tool in general practice as pilot test was reported. In Hallym University, CAT has been introduced in the evaluation of the students' performance as in-course general evaluation test and parasitology test. Another examples of application of CAT for high stakes examination are Medical Council of Canada Qualifying Examination - Part 1 in Canada and National Council Licensure EXamination - Registered Nurse in USA. CAT has some merits such as accurate estimation of the ability parameters of the examinees and the shorter period of examination. To apply the CAT in medical education more actively, medical teachers should have an interest in the modern measurement theories such as item response theory and technologies. It is still uncertain if CAT may be prosperous in the medical education as a tool for the measurement of the examinees' ability. However, we should prepare the era of application of CAT in high stakes examination such as medical licensing examination.

A nationwide survey on the prevalence of intestinal parasitic infections in the Republic of Korea, 2004

National surveys on the prevalence of intestinal parasitic infections have been carried out every 5-7 years since 1971 in the Republic of Korea in order to establish control measures. The present nationwide survey was conducted from June to December 2004. The 10% population sampling data of Population and Housing Census by the Korean government in 2000 was used as the survey population. One sample was selected randomly from each of the 22,858 registered subjects, and a total of 20,541 people were ultimately included in this survey. Fecal examinations were performed by the cellophane thick smear and saturated brine flotation techniques. Pinworm infection was examined by cello-tape anal swab method. This survey also included a questionnaire study for a socioeconomic analysis. The total helminth egg positive rate was 3.7%, and the estimated total positive number among nationwide people was 1,780,000. The rates in urban and rural areas were 3.1% and 6.8%, respectively. As the total egg positive rate in the 6th survey in 1997 was 2.4%, the present survey showed that there was a considerable degree of increase in the prevalence rate of intestinal parasitic infections over the 7-year period following the 6th survey. The largest increases occurred in the egg positive rates of Clonorchis sinensis and heterophyids including Metagonimus yokogawai.

Ultrastructural localization of Toxocara canis larval antigen reacted with a seropositive human serum

Excretory-secretory products of Toxocara canis larvae have been considered as a major functional antigen in immune responses against toxocariasis. We studied ultrastructural localization of T. canis second-stage larval antigen using a seropositive human serum under immunogold electron microscopy. High-density gold particles were observed in the secretory cells, excretory duct, intestinal epithelium, and cuticle of the larval worm sections. The distribution of the positive reactions in the larval worms suggests that the nature of the antigen is excretory-secretory antigen including waste metabolites and secretory enzymes.

Toxocariasis and ingestion of raw cow liver in patients with eosinophilia

Ingestion of raw animal liver has been suggested as a possible mode of infection of human toxocariasis. We evaluated the relationship between toxocariasis and the ingestion of raw meat in patients with eosinophilia of unknown etiology. The study population consisted of 120 patients presenting with peripheral blood eosinophilia (>500 cells/microliter or >10% of the white blood cell count). They were divided into 2 groups: 104 seropositive patients based on a Toxocara excretory-secretory IgG ELISA and 16 seronegative patients. While 25.0% of seronegative patients had a recent history of eating raw cow liver, 87.5% of seropositive patients had this history. Multivariate statistical analysis showed that a recent history of eating raw cow liver was related to an increased risk of toxocariasis. Collectively, it is proposed that raw cow liver is a significant infection source of toxocariasis in the patients with eosinophilia of unknown etiology.

Association of C-509T and T869C polymorphisms of transforming growth factor-beta1 gene with chronic allograft nephropathy and graft survival in Korean renal transplant recipients

PURPOSE

Transforming growth factor-beta1 (TGF-beta1) has been associated with the promotion of renal allograft interstitial fibrosis and thereby chronic allograft nephropathy (CAN). The literature on TGF-beta1 polymorphisms and their importance in graft survival and CAN is not conclusive.

METHODS

TGF-beta1 gene polymorphisms (C-509T and T869C) were examined in a group of 207 Korean renal transplant recipients using real-time polymerase chain reaction assays. The CAN group (n = 18) was defined by a typical biopsy confirming CAN or chronic calcineurin inhibitor nephrotoxicity. The rest of the patients were classified into the No CAN group (n = 189).

RESULTS

No significant differences were observed in the genotype distributions of both C-509T and T869 polymorphisms between the two groups. Allele frequencies and age-, sex-, HLA mismatch-adjusted odds ratio of each genotype as assessed by logistic regression analysis were also not significantly different between the two groups. Linkage disequilibrium coefficients between polymorphisms indicated that investigated polymorphisms of TGF-beta1 (D' = 0.98) were in tight linkage. However, there were no significant differences in the frequencies of the reconstructed haplotypes between the two groups. Kaplan-Meier method and log-rank tests did not indicate any statistically significant effects of TGF-beta1 gene polymorphisms on graft survival.

CONCLUSION

TGF-beta1 gene polymorphisms (C-509T, T869C) are not significantly associated with an increased risk of development of CAN and graft survival in Korean renal transplant recipients.

Terminology and classification of congenital vascular malformations

Venous malformation (VM) is a congenital vascular malformation (CVM) that develops along the venous system through the various stages of embryogenesis. Older terminology and classification were often misleading and confusing. A newer classification system has emerged that is based on advances in the study of these conditions and is useful in contemporary management. The Hamburg classification was introduced after reappraisal of older terminology and has become the standard system for contemporary classification, which is based on anatomical, pathological and embryological criteria.

Seroprevalence of toxocariasis among healthy people with eosinophilia

The aim of this study is to determine the Toxocara seropositive rate among healthy people with eosinophilia. A total of 97 people residing in Seoul who were healthy and whose blood eosinophilia was over 10%, as shown by regular health check-ups in 2004, were subjected to this study. Their sera were tested by immunoblotting and ELISA with the antigen of larval Toxocara canis excretory-secretory (ES) protein. Sixty-five sera were band-positive (67.0%). The seropositve control sera were positive to band sizes of 66 kDa, 56 kDa, 32 kDa, and 13 kDa. In ELISA, 63 sera (65.0%) were positive to T. canis ES protein. There was no significant correlation between the IgG ELISA titer and the level of eosinophilia (r = 0.156, P = 0.156). As there were insufficient data to determine whether there were cross-reactions with other helminthic infections, or whether atopy occurred, further studies are required to verify the cause of the seropositive reactions against T. canis ES antigen. Toxocariasis seropositivity is suggested to be the major cause of eosinophilia, since the Toxocara seroprevalence among Korean rural adults was shown to be approximately 5%.

Pulsed-UV light inactivation of Cryptosporidium parvum

Cryptosporidium parvum is an organism that threatens public health in the water industry. It is critical to develop improved detection methods as well as disinfection methods for protecting against cryptosporidiosis, which is caused by C. parvum. In this study, we investigated the ability of pulsed-light irradiation at 200-900 nm to inactivate C. parvum. Absolute quantitative real-time PCR was performed with cDNA made from total RNA extracted from C. parvum oocysts or HCT-8 cells infected with C. parvum oocysts in vitro. C. parvum oocysts in 100-mL quartz flasks were positioned 20, 30, and 40 cm from the light source, and the duration of irradiation was either 5 or 60 s. The reductions in oocyst viability (4.9 log10) and infectivity (6 log10) were maximal when the C. parvum oocysts were irradiated 20 cm from the pulsed-light source for 60 s, for which the UV dose was 278 mJ/cm2. The minimum dose of pulsed-UV light required for effective reduction in C. parvum infectivity (2 log10) was 15 mJ/cm2, which was achieved by 5 s of irradiation at 30 cm from the light source. This study confirmed that short-duration pulsed-UV light is an effective disinfection measure for C. parvum.

Molecular phylogeny of parasitic Platyhelminthes based on sequences of partial 28S rDNA D1 and mitochondrial cytochrome c oxidase subunit I

The phylogenic relationships existing among 14 parasitic Platyhelminthes in the Republic of Korea were investigated via the use of the partial 28S ribosomal DNA (rDNA) D1 region and the partial mitochondrial cytochrome c oxidase subunit 1 (mCOI) DNA sequences. The nucleotide sequences were analyzed by length, G + C %, nucleotide differences and gaps in order to determine the analyzed phylogenic relationships. The phylogenic patterns of the 28S rDNA D1 and mCOI regions were closely related within the same class and order as analyzed by the PAUP 4.0 program, with the exception of a few species. These findings indicate that the 28S rDNA gene sequence is more highly conserved than are the mCOI gene sequences. The 28S rDNA gene may prove useful in studies of the systematics and population genetic structures of parasitic Platyhelminthes.

CP2 gene as a useful viability marker for Cryptosporidium parvum

The validity of the CP2 gene of Cryptosporidium parvum as a viability marker was evaluated using absolute quantitative real-time polymerase chain reaction (qPCR) assays. Total ribonucleic acid (RNA) was isolated from live and heat-killed C. parvum oocysts, and complementary deoxyribonucleic acid was synthesized and used as a template. The most accurate number of viable C. parvum oocysts was predicted when the CP2 gene was used as a target gene. The lower detection limit of the CP2 gene was ten oocysts, which was the most sensitive among examined target genes. With heat shock induction, only hsp70 messenger RNA (mRNA) was induced, and the predicted viable oocyst number was increased by heat shock for this marker. The CP2, hsp70, Cryptosporidium oocyst wall protein, and beta-tubulin mRNAs were not detected in heat-killed oocysts, but the 18S ribosomal ribonucleic acid (rRNA) showed heat stability until 48 h after heat killing. Although the 18S rRNA demonstrated the fastest response in crossing point (CP) value among the examined primer sets in qPCR, overestimation of viable oocysts was noted in the analysis with this gene. In conclusion, the CP2 gene was identified as the most sensitive, reliable, and accurate candidate of a viability marker of C. parvum by qPCR evaluation.

Mechanisms of melanogenesis inhibition by 2,5-dimethyl-4-hydroxy-3(2H)-furanone

BACKGROUND

Increased production and accumulation of melanin is characteristic of a large number of skin diseases, including acquired hyperpigmentation such as melasma, postinflammatory melanoderma and solar lentigo. Thus, there is a increasing need for the development of depigmenting agents.

OBJECTIVES

To evaluate the depigmenting capacity of 2,5-dimethyl-4-hydroxy-3(2H)-furanone (DMHF) and to elucidate the mechanisms by which it inhibits alpha-melanocyte-stimulating hormone (alpha-MSH)-induced melanogenesis in B16 melanoma cells in vitro.

METHODS

Several experiments were performed in B16 melanoma cells. We studied melanin content, tyrosinase activity and cAMP production, and performed cAMP response element (CRE) luciferase reporter assay and Western blots for proteins involved in melanogenesis.

RESULTS

The melanin content and tyrosinase activity induced by alpha-MSH were inhibited significantly by DMHF. To clarify the mechanism of the depigmenting property of DMHF, we examined the involvement of DMHF in cAMP signalling induced by alpha-MSH. In CRE luciferase reporter assay, CRE reporter activation induced by alpha-MSH was inhibited by DMHF. Additionally, although DMHF did not inhibit cAMP production by alpha-MSH, both CRE binding protein (CREB) phosphorylation and the reduction of glycogen synthase kinase-3beta phosphorylation by alpha-MSH were blocked by DMHF. These data suggest that DMHF inhibits the downstream step of cAMP production induced by alpha-MSH, consequently inhibiting melanogenesis. This suggestion was further confirmed by the fact that the increased production levels of microphthalmia-associated transcription factor, tyrosinase and tyrosinase-related protein-1 induced by alpha-MSH were all reduced by DMHF in B16 melanoma cells.

CONCLUSIONS

Our study shows that DMHF inhibits alpha-MSH-induced melanogenesis by suppressing CREB phosphorylation, which is induced by protein kinase A, and suggests that DMHF may be an effective inhibitor of hyperpigmentation.

Intestinal protozoan infections and echinococcosis in the inhabitants of Dornod and Selenge, Mongolia (2003)

The status of intestinal parasitic infections and seroprevalence of cystic echinococcosis in the inhabitants in Dornod and Selenge, Mongolia, was observed with stool and serum samples from 165 and 683 residents from August 9 to August 15, 2003. A total of 10 inhabitants (6.1%) were found to be infected with protozoan cysts or oocysts by stool examinations; 7, 1 and 2 cases with Entamoeba coli, Giardia lamblia and Cryptosporidium parvum, respectively. A total of 62 people (9.1%) revealed significantly high levels of specific antibodies against Echinococcus granulosus by enzyme-linked immunosorbent assay (ELISA). The surveyed areas are rural areas and the sanitized tab water is not available. There is a possibility of endemic transmission of water-borne protozoan diseases in these areas. The clinical echinococcosis is needed to be searched from the seropositive inhabitants.

Cloning of the novel putative apoptosis-related gene of Spirometra erinacei (Order Pseudophyllidae)

We postulated that apolysis was processed in accordance with apoptotic changes occurring in a cestode, Spirometra erinacei (Pseudophyllidea). We cloned the novel putative apoptosis-associated gene from S. erinacei via screening of a S. erinacei cDNA library with a ced-3 gene (activator of apoptosis) probe from Caenorhabditis elegans. We identified a 261-bp cDNA sequence, which encodes for an 86-amino acid protein. The cloned gene expression was observed in the neck and gravid proglottids via Northern blotting, using cloned cDNA inserts as probes, but the clone was not expressed in any of other tissues. We suggest that this gene may be involved in the apolysis of S. erinacei during normal tissue development and differentiation in cestode parasites.

A successful experience of soil-transmitted helminth control in the Republic of Korea

Soil-transmitted helminths (STH), namely Ascaris, Trichuris and hookworms (Ancylostoma and Necator), present a global health problem to about a half of the earthos population. In the Republic of Korea, STH were highly prevalent and were considered a high priority target for national control. To promote the control, a non-governmental organization named Korea Association for Parasite Eradication (currently Korea Association of Health Promotion) was founded in 1964, and mass fecal examination followed by selective mass chemotherapy with anthelmintics was performed twice a year from 1969 to 1995 targeting whole nationwide schoolchildren. Meanwhile, decreasing patterns of national STH infections have been monitored by 7 timeso quinquennial national surveys targeting general population. In 1971, the overall intestinal helminth egg positive rate was 84.3% (Ascaris 58.2%, Trichuris 65.4%, and hookworms 10.7%), which became 63.2% in 1976, 41.1% in 1981, 12.9% in 1986, 3.8% in 1992, 2.4% in 1997, and 4.3% (Ascaris 0.03%, Trichuris 0.02%, and hookworms 0%) in 2004. During the control period, national economy rapidly developed, and living standards including environment, sanitation, and agricultural technology greatly improved, which undoubtedly boosted the STH control effects. Our experience indicates that social driving force to establish an eligible national control system to conduct repeated mass chemotherapy, together with improvement of environment and sanitation, is important for initiating and achieving STH control in a developing community.

Test equating of the Medical Licensing Examination in 2003 and 2004 based on the item response theory

The passing rate of the Medical Licensing Examination has been variable, which probably originated from the difference in the difficulty of items and/or difference in the ability level of examinees. We tried to explain the origin of the difference using the test equating method based on the item response theory. The number of items and examinees were 500, 3,647 in 2003 and 550, 3,879 in 2004. Common item nonequivalent group design was used for 30 common items. Item and ability parameters were calculated by three parametric logistic models using ICL. Scale transformation and true score equating were executed using ST and PIE. The mean of difficulty index of the year 2003 was -0.957 (SD 2.628) and that of 2004 after equating was -1.456 (SD 3.399). The mean of discrimination index of year 2003 was 0.487 (SD 0.242) and that of 2004 was 0.363 (SD 0.193). The mean of ability parameter of year 2003 was 0.00617 (SD 0.96605) and that of year 2004 was 0.94636 (SD 1.32960). The difference of the equated true score at the same ability level was high at the range of score of 200-350. The reason for the difference in passing rates over two consecutive years was due to the fact that the Examination in 2004 was easier and the abilities of the examinees in 2004 were higher. In addition, the passing rates of examinees with score of 270-294 in 2003, and those with 322-343 in 2004, were affected by the examination year.

Factors Affecting the Long-term Patency of Crossover Femorofemoral Bypass Graft

OBJECTIVES

To determine the factors affecting long-term patency of crossover femorofemoral bypass (FFB) graft.

DESIGN

A retrospective clinical study of a prospectively registered database.

MATERIALS

Two hundred and sixteen FFBs performed for 192 patients with atherosclerotic iliac occlusive disease.

METHODS

The clinical and surgical variables influencing graft patency were assessed with log-rank test and Cox's proportional hazard analysis.

RESULTS

The primary patency rates of all FFB grafts at 3 and 5 years were 73+/-4 and 65+/-5%, respectively. By multivariate analysis, hypertension (Odds ratio 2.8, P=0.002) and critical ischemia (Odds ratio 0.42, P=0.01) significantly (P<.05) influenced long-term patency of FFB grafts.

CONCLUSION

The long-term patency of FFB grafts was not affected by procedural modifications. Graft patency was inferior in patients with severe lower limb ischemia but superior in patients with hypertension. Further study is required to clarify the mechanism of an unexpected beneficial effect of hypertension on FFB graft patency.

Prevalence of Toxocara canis, Toxascaris leonina and Dirofilaria immitis in dogs in Chuncheon, Korea (2004)

The intestines and hearts of dogs were examined for Toxocara canis, Toxascaris leonina, and Dirofilaria immitis, after necropsy between June 26 and September 29, 2004 in Chuncheon, Korea. Of the 662 dogs examined, 6 were infected with T. canis (0.9%), 86 with T. leonina (13.0%). Fifty dogs were infected with D. immitis among 500 dogs examined (10.0%). Five were co-infected with T. canis and T. leonina, and three were co-infected with T. leonina and D. immitis. The cumulative positive infection rate for three species was 134/662 (20.2%). Considering previously reported seropositive rates of T. canis excretory-secretory antigen, i.e., 5% in the adult population in Korea, the possibility of toxocariasis caused by T. leonina should be reevaluated.