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Human immunodeficiency virus (HIV) infection management has recently become more successful. While the life expectancy of HIV-infected patients increased, the prevalence of non-acquired immunodeficiency syndrome-defining cancers, such as gastric cancer, also increased. Helicobacter pylori is associated with gastric cancer, the most common cancer and the fourth leading cause of cancer-related deaths in South Korea, which has the highest incidence of chronic gastric mucosa inflammation. Here, the seroprevalence and risk factors of H. pylori infection in Korean HIV-infected patients were evaluated.Three hundred HIV-infected patients attending the Outpatient Department of Pusan National University Hospital were prospectively enrolled from October 2018 to February 2019. Socio-demographic information was evaluated using questionnaires, and the serological status of H. pylori infection was analyzed for anti-H. pylori IgG antibodies.The overall seropositivity of H. pylori was 32.7%, and 254 patients (84.7%) were male. The risk factors significantly associated with H. pylori seropositivity were: age of 40-49 years (odds ratio [OR] = 5.00; 95% confidence interval [CI] 1.30-19.17), age of 50-59 years (OR = 3.93; 95% CI 1.05-14.73), CD4 cell counts of 350-500/μL (OR = 4.23; 95% CI 1.53-11.65), CD4 cell counts ≥500/μL (OR = 2.78; 95% CI 1.15-6.72), and a weekly average alcohol consumption of at least one alcoholic beverage (OR = 1.78; 95% CI 1.05-2.99).The seroprevalence of H. pylori is significantly associated with alcohol consumption, high CD4 cell count, and the age group of 40-59 years.

Background Stenotrophomonas maltophilia (SM) is an important emerging nosocomial pathogen. This study aimed to describe the epidemiological, clinical, and microbiological charateristics of SM bacteremia at a tertiary care hospital in Korea over 7 years. Methods A retrospective study was conducted at a 1150-bed tertiary care hospital in Busan, South Korea. Data were collected between January, 2013 and November, 2019. Results A total of 79 bacteremia patients (median age: 61 years; 62% males) were reviewed; 38 (48.1%) were in 2013-2016 and 41 (51.9%) were in 2017-2019. The overall SM bacteremia-related 30-days mortality was 31.6%. Susceptibility to levofloxacin, sulfamethoxazole-trimethoprim (SMX/TMP) and minocycline were 87.3%, 92.4% and 100%, respectively. The most common clinical syndrome was central line-associated bloodstream infection (n=37, 46.8%). The others were intra-abdominal infection (n=18, 22.8%), skin and soft tissue infection (n=5, 6.3%) and pneumonia (n=5, 6.3%). In 50.6%, SM was the only pathogen of bacteremia, whereas in 49.4%, more than one causative organisms were isolated. Acinetobacter baumanii (in 8 cases) was the most frequent co-isolated pathogen, followed by Enterococcus faecium (in 6 cases), Pseudomonas aeruginosa (in 5 cases), Staphylococcus epidermidis (in 5 cases), Enterococcus gallinarum (in 3 cases) and Klebsiella pneumoniae (in 3 cases). Age (OR, 6.60; 95% Cl, 1.59-27.41; P = 0.009), inappropriate antimicrobial treatment (OR, 3.47; 95% Cl, 1.14-10.56; P = 0.029), and levofloxacin-resistant strains (OR, 7.86; 95% Cl, 1.20-51.41; P = 0.031) were independent risk factors for SM bacteremia-related 30-days mortality in multivariate analysis. Conclusion SM bacteremia has a high early mortality rate. In our study, old age, inappropriate antimicrobial treatment and levofloxacin-resistant strains were significant independent risk factors for early mortality in SM bacteremia patients. Early diagnosis and immediate use of appropriate antibiotics are recommended to improve mortality of SM bacteremia. Disclosures All Authors: No reported disclosures.

Kudoa septempunctata is a myxosporean parasite that infects the trunk muscles of olive flounder (Paralichthys olivaceus) and has been reported to cause foodborne illnesses in humans. However, the molecular mechanisms underlying K. septempunctata spore toxicity remain largely unknown. In this study, the gastroenteropathy of K. septempunctata was examined in human colon adenocarcinoma cells as well as experimental mice inoculated with spores. We found that K. septempunctata decreased transepithelial resistance and disrupted epithelial tight junctions by deleting ZO-1 in Caco-2 monolayers. Additionally, serotonin (5-HT), an emetic neurotransmitter, was increased in K. septempunctata-inoculated cells. In vivo, K. septempunctata spores induced diarrhea in suckling mice (80% in ddY and 70% in ICR mice), with a minimum provocative dose of 2 × 105 K. septempunctata spores. In house musk shrews, K. septempunctata induced emesis within 1 h and induced serotonin secretion in the intestinal epithelium. In conclusion, K. septempunctata may induce diarrhea and emesis by increasing intestinal permeability and serotonin secretion.

Epidemiological information on hepatitis A among people living with HIV (PLHIV) in Korea is scarce. This retrospective study was performed at a tertiary care hospital and included 756 PLHIV with anti- hepatitis A virus (HAV) IgG tests. Between 2012 and 2021, the age at anti-HAV IgG seroconversion is gradually delayed, and the proportion of individuals susceptible to HAV infection increased among adult PLHIV in Korea. The independent risk factors for HAV seropositivity were female sex and HBs antigen (Ag) positivity. Therefore, HAV vaccination is highly recommended for young PLHIV, especially for women or HBsAg-positive individuals.

Background Lopinavir/ritonavir (LPV/r) and hydroxychloroquine (HCQ) are both being used to treat coronavirus disease 2019 (COVID-19), but their relative effectiveness is unknown. The purpose of this study was to compare the clinical outcomes of patients treated for COVID-19 with LPV/r or HCQ. Methods A retrospective observational study was conducted at 2 hospitals in Busan, South Korea, where approximately 90% of COVID-19 patients were hospitalised during February/March 2020. All patients aged ≥15 years that were hospitalised with mild or moderately severe COVID-19 received LPV/r or HCQ as their initial treatment and were included in the analysis. Results Among the 72 patients with mild-to-moderate disease severity on admission, 45 received LPV/r and 27 received HCQ as their initial therapy. A higher proportion of the LPV/r group had pneumonia on admission (LPV/r, 49% vs HCQ, 15%), but there were no other significant differences in the demographic or clinical characteristics between groups. Switching therapy due to clinical failure was significantly more common in the HCQ group than in the LPV/r group (41% [11/27] and 2% [1/45], respectively, P = .001). Disease progression was also significantly more common in the HCQ group than in the LPV/r group (44% [12/27] and 18% [8/45], respectively, P = .030). Conclusion Based on our study results, HCQ shows no apparent advantage compared to LPV/r for preventing progression to severe disease in patients with COVID-19.

Background Regdanvimab (CT-P59) is a neutralizing antibody authorized in Republic of Korea for the treatment of adult patients with moderate or mild-COVID-19 who are not on supplemental oxygen and have high risk of progressing to severe disease (age ≥50 years or comorbidities). This study evaluated the clinical efficacy, safety and medical utilization/costs associated with real-world regdanvimab therapy. Methods This non-interventional, retrospective cohort study included adult patients with confirmed mild-to-moderate SARS-CoV-2 infection. Patients treated with regdanvimab were compared with controls who had received other therapies. The primary endpoint was the proportion of patients progressing to severe/critical COVID-19 or death due to SARS-CoV-2 infection up to Day 28. Propensity score matching was applied to efficacy analyses. Results Overall, 552 patients were included in the Safety and Efficacy Sets (regdanvimab, n=156; control, n=396) and 274 patients in the propensity score–matched (PSM) Efficacy Set (regdanvimab, n=113; control, n=161). In the PSM Set, the risk of severe/critical COVID-19 or death was significantly lower in the regdanvimab group (7.1% vs 16.1%, P=0.0263); supplemental oxygen was required by 8.0% and 18.6% of patients in the regdanvimab and control groups, respectively (P=0.0128). There were no unexpected safety findings in the regdanvimab group. Medical utilization analysis showed an overall cost reduction with regdanvimab compared with control treatments. Conclusions Regdanvimab significantly reduced the proportion of patients progressing to severe/critical disease or dying of SARS-CoV-2 infection. This study shows the potential benefits of regdanvimab in reducing disease severity and improving medical utility in patients with COVID-19.

It is known that vitamin D is associated with immune cell growth, and an association between vitamin D deficiency and development of chronic infections such as tuberculosis has been reported. However, there have been few studies concerning the association between vitamin D deficiency and opportunistic infection (OI) in people living with HIV/AIDS (PWHA).PWHAs who had vitamin D (25-OH vitamin D, 25OHD) test results from 2012 to 2017 were enrolled. All enrolled PWHAs were divided into a vitamin D-deficient group and non-deficient group according to the 25OHD cutoff set by ROC curve analysis. The rates of OIs were compared between the two groups.Among 440 enrolled PWHAs, 394 (89.5%) were male, 32 were ≥ 65 years (13.4%), 237 (53.9%) were ART-naïve, and 107 (24.3%) had CD4 + T cell200/L. Seventy-three cases of OIs occurred in 63 PWHAs (14.3%); the most common OI was tuberculosis (27, 6.1%) followed by pneumocystis pneumonia (PCP) (25, 5.7%), and Cytomegalovirus (CMV) diseases (10, 2.3%). In the ROC curve analysis, the AUC was 0.71 (95% CI 0.64- 0.79, P 0.001) and the optimal cutoffs of 25OHD to predict OIs was 14 ng/mL.Overall OI development was significantly more prevalent in the vitamin D-deficiency group (aOR 3.05, 95% CI 1.43-6.48); tuberculosis (aOR 3.51, 95% CI 1.22-10.05) and CMV disease (aOR 10.13, 95% CI 1.11-92.03) were significantly associated with vitamin D deficiency, whereas PCP was not (aOR 1.32, 95% CI 0.44-3.98).Stringent cutoffs of vitamin D deficiency (14 ng/mL) were well correlated with development of OIs in PWHAs. Vitamin D deficiency was associated with development of OIs, particularly tuberculosis and CMV infections.

BACKGROUND Recent data suggests the inoculum effect of methicillin-susceptible Staphylococcus aureus (MSSA) against beta-lactam antibiotics and their association with functionality or genotypic variation of agr locus. METHODS MSSA blood isolates were collected at a tertiary care hospital in Korea from June 2014 to December 2017. The functionality of the agr operon was measured by δ-hemolysin assays. Multiplex PCR was performed to determine the agr genotype. The cefazolin minimum inhibitory concentrations (MICs) at a high inoculum concentration (~5 × 10⁷ CFU/ml) were compared to the MICs at a standard inoculum concentration (~5 × 10⁵ CFU/ml) to identify strains with the cefazolin inoculum effect (CIE). The DNA sequencing of blaZ gene was performed to classify the blaZ genotype. RESULTS Among the 195 MSSA blood isolates, agr genotype I was most common (68.2%), followed by type III (16.4%), type IV (9.2%), and type II (6.2%). Sixty-seven (34.3%) MSSA isolates had dysfunctional agr, but neither CIE nor blaZ genotype was associated with dysfunctional agr. The MSSA with agr type III genotype exhibited significantly higher CIE positivity (agr III 43.8% vs. non-agr III 5.5%, P

Dysfunctional accessory gene regulator (agr) is associated with unfavorable outcomes in invasive methicillin-resistant Staphylococcus aureus infections. However, it is unknown whether this association persists in methicillin-susceptible Staphylococcus aureus bacteremia (MSSA-B). This study evaluated the association between agr dysfunction and mortality in patients with MSSA-B. This retrospective cohort study included MSSA-B patients (≥15 years) enrolled from June 2014 to June 2019 and retrospectively collected their demographic and clinical information. Stored causative strains were measured for agr functionality by δ-hemolysin production assays. Among 244 MSSA-B patients, 91 (37.3%) and 153 (62.7%) had dysfunctional and functional agr MSSA-B, respectively. Ninety-day mortality occurred in 18.7% and 17.6% dysfunctional and functional groups, respectively (P = 0.97). Kaplan-Meier analysis showed that mortality due to dysfunctional agr MSSA-B was not significantly higher (P = 0.82). Age, sites, the severity of infection, and comorbidity adjusted hazard ratio (aHR) of the dysfunctional group for 90-day mortality was 1.303 (95% confidence interval [CI], 0.698 to 2.436, P = 0.41). Mortality due to MSSA-B with sequential organ failure assessment (SOFA) scores of 2 to 5 was significantly higher in the dysfunctional group (P = 0.03), and the dysfunctional agr aHR for 90-day mortality was 3.260 (95% CI, 1.050 to 10.118, P = 0.04). The agr dysfunction of causative organisms can have a significant effect on the outcomes of MSSA-B in patients with moderate severity (SOFA scores 2 to 5). IMPORTANCE Few studies have examined the association between methicillin-susceptible Staphylococcus aureus (MSSA) infection and accessory gene regulator (agr) functionality. We evaluated the association between agr dysfunction and mortality in patients with MSSA bacteremia. Dysfunctional agr is associated with lower survival in MSSA bacteremia patients with moderately severe sequential organ failure assessment (SOFA) scores of 2 to 5. We found that the agr functionality of causative organisms may have an effect on patients’ outcomes in MSSA like in methicillin-resistant S. aureus.

The accessory gene regulator (agr) locus of Staphylococcus aureus is a quorum-sensing virulence regulator. Although there are many studies concerning the effect of dysfunctional agr on the outcomes of S. aureus infection, there is no systematic review to date. We systematically searched for clinical studies reporting outcomes of invasive S. aureus infections and the proportion of dysfunctional agr among their causative strains, and we performed a meta-analysis to obtain estimates of the odds of outcomes of invasive S. aureus infection with dysfunctional versus functional agr. Of 289 articles identified by our research strategy, 20 studies were meta-analysed for crude analysis of the impact of dysfunctional agr on outcomes of invasive S. aureus infection. Dysfunctional agr was generally associated with unfavourable outcomes (OR 1.32, 95% CI 1.05–1.66), and the impact of dysfunctional agr on outcome was more prominent in invasive methicillin-resistant S. aureus (MRSA) infections (OR 1.54, CI 1.20–1.97). Nine studies were meta-analysed for the impact of dysfunctional agr on the 30-day mortality of invasive S. aureus infection. Invasive MRSA infection with dysfunctional agr exhibited higher 30-day mortality (OR 1.40, CI 1.03–1.90) than that with functional agr. On the other hand, invasive MSSA infection with dysfunctional agr exhibited lower 30-day mortality (OR 0.51, CI 0.27–0.95). In the post hoc subgroup analysis by the site of MRSA infection, dysfunctional agr was associated with higher 30-day mortality in MRSA pneumonia (OR 2.48, CI 1.17–5.25). The effect of dysfunctional agr on the outcome of invasive S. aureus infection may vary depending on various conditions, such as oxacillin susceptibility and the site of infection. Dysfunctional agr was generally associated with unfavourable clinical outcomes and its effect was prominent in MRSA and pneumonia. Dysfunctional agr may be applicable for outcome prediction in cases of invasive MRSA infection with hardly eradicable foci such as pneumonia., This work was supported by a National Research Foundation of Korea (NRF) Grant funded by the Korean Government (MSIP) (NRF-2018R1A1A1A05079369).

Transmitted drug resistance (TDR) in treatment-naive HIV patients can contribute to failure of initial antiretroviral therapy. In Korea, there has been a gradual increase in TDR, but the recent increase in the use of integrase strand transfer inhibitors (INSTIs) could affect TDR trends and INSTI resistance mutations. We evaluated the patterns of TDR in newly diagnosed HIV patients over time from 2011 to 2019. We analyzed the genotypic resistance of strains in 336 patients and sequenced the integrase gene in 71 among 336 subjects. The overall prevalence of TDR was 5.9% (20 of 336 patients), and it showed a tendency to increase over time (5.1% in 2011-2013, 6.1% in 2014-2016, and 7.2% in 2017-2019

Background: Lopinavir/ritonavir and hydroxychloroquine are both being used to treat COVID-19, but their relative effectiveness is unknown. The purpose of this study was to compare the clinical outcomes of patients treated for COVID-19 with lopinavir/ritonavir (LPV/r) or hydroxychloroquine (HCQ).Methods: A retrospective cohort study was conducted at 2 hospitals in Busan, South Korea, that treated approximately 90% of COVID-19 patients hospitalized in Busan during the study period. All patients aged ≥15 years that were hospitalized with mild-or-moderate COVID-19 received LPV/r or HCQ as their initial treatment and were included in the analysis.Results: Among the 72 patients with mild-to-moderate disease severity on admission, 45 received LPV/r and 27 received HCQ as their initial therapy. A higher proportion of the LPV group had pneumonia on admission (LPV 49% vs. HCQ 15%), but there were no other significant differences in the demographic or clinical characteristics between groups.Switching therapy due to clinical failure was significantly more common in the HCQ group than in the LPV/r group (41% [11/27] and 2% [1/45], respectively, P=0.001). Disease progression was also significantly more common in the HCQ group than in the LPV/r group (44% [12/27] and 18% [8/45], respectively, P=0.030).Conclusions: LPV/r appears to be more effective than HCQ at preventing progression to severe disease in patients with COVID-19.

The histamine H4 receptor (H4R), a member of the G-protein coupled receptor family, has been considered as a potential therapeutic target for treating atopic dermatitis (AD). A large number of H4R antagonists have been disclosed, but no efficient agents controlling both pruritus and inflammation in AD have been developed yet. Here, we have discovered a novel class of orally available H4R antagonists showing strong anti-itching and anti-inflammation activity as well as excellent selectivity against off-targets. A pharmacophore-based virtual screening system constructed in-house successfully identified initial hit compound 9, and the subsequent homology model-guided optimization efficiently led us to discover pyrido[2,3- e]tetrazolo[1,5- a]pyrazine analogue 48 as a novel chemotype of a potent and highly selective H4R antagonist. Importantly, orally administered compound 48 exhibits remarkable efficacy on antipruritus and anti-inflammation with a favorable pharmacokinetic (PK) profile in several mouse models of AD. Thus, these data strongly suggest that our compound 48 is a promising clinical candidate for treatment of AD.

Background Data on illicit drug use by Korean people infected with HIV are lacking. Here, we examined the prevalence and patterns of illicit drug use among people infected with HIV in Korea. Material and methods In this cross-sectional study, we included all patients infected with HIV who visited a tertiary care hospital in Korea from January 1990 to May 2020. Sociodemographic data of patients, including drug use, were collected at the first visit and during follow-up. Results Among 1,267 patients, 5.13% reported the use of an illicit drug in their lifetime, and 2.61% were users of injection drugs. The most commonly used drugs were cannabis/marijuana and methamphetamine, followed by nitrite inhalants, cocaine, dextromethorphan, carisoprodol, and 3,4-methylenedioxymethamphetamine. The illicit drug users tended to be younger than non-users, homosexuals/bisexuals, and infected with hepatitis C virus (HCV); they had a higher CD4+ cell count than non-users. Among 65 users of illicit drugs, only 24.6% revealed their drug use at the first visit interview, and 24.6% reported using two or more drugs in their lifetime. Individuals who used injection drugs were more likely to be arrested for drug-related charges than the users of non-injection drugs. Moreover, they tended to be heavy users of illicit drugs, to report using two or more drugs in their lifetime, and to be HCV seropositive. In contrast, the users of non-injection drugs were more likely to be experimental users and to start using drugs overseas for the first time, but less likely to report their drug use at the first interview. Conclusions The prevalence of illicit drug use in people with HIV infection in Korea may have been underestimated. Further research based on more accurate measurements are warranted.

Background Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are associated with high mortality rates and their treatment is difficult because treatment is limited to certain antibiotics, such as colistin and tigecycline. We aimed to perform active surveillance culture of CRE (ASC-CRE) to monitor the prevalence of CRE acquisition during intensive care unit (ICU) care and to examine the potential risk factors associated with CRE acquisition. Methods We conducted ASC-CRE on patients who were admitted to the ICU in the emergency room at a tertiary hospital. Rectal swabs were analyzed using methods established by the Centers for Disease Control and Prevention. To detect carbapenemase-producing CRE, a polymerase chain reaction assay to detect five carbapenemase genes (blaNDM, blaKPC, blaVIM, blaIMP-1, and blaOXA-48) was performed. Results There were 22 CRE acquisition in 21 patients (2.6%, 21/810) and the incidence of CRE acquisition was 4.3/1,000 person-days, respectively. The most common species detected was Klebsiella pneumoniae (72.7%, 16/22), and 9 carbapenemase-producing CREs (7 blaKPC and 2 blaNDM) were detected. Independent risk factors associated with CRE acquisition were men gender (adjusted odds ratio [aOR], 5.3; 95% confidence interval [CI], 1.3–21.3), history of admission within one year (aOR, 3.9; 95% CI, 1.2–12.1), co-colonization with multidrug-resistant Acinetobacter baumannii (aOR, 15.6; 95% CI, 3.6–67.8) and extended-spectrum β-lactamases-producing bacteria (aOR, 4.7; 95% CI, 1.5–14.6), and exposure to glycopeptide antibiotics (aOR, 3.6; 95% CI, 1.3–9.9). Conclusion The identification of patients with risk factors for CRE acquisition and early detection of CRE acquisition using ASC-CRE may be useful for CRE control., Graphical Abstract

BACKGROUND Gastrointestinal (GI) diseases are common in patients with human immunodeficiency virus (HIV) infection. There are few reports on the epidemiology and endoscopic findings of gastric cancer in patients with HIV infection in the era of combination antiretroviral therapy (cART). We retrospectively analyzed upper GI endoscopic findings in patients with HIV infection and investigated their role as gastric cancer screening. MATERIALS AND METHODS We retrospectively investigated endoscopies conducted in Korean patients with HIV infection referred for endoscopy at a tertiary hospital between January 2004 and December 2018. Endoscopic and pathologic findings were analyzed according to the reason for endoscopy, patient age, and cART duration. All endoscopic findings were reevaluated by gastroenterologists. RESULTS Three hundred ten endoscopies in 201 patients with HIV infection were investigated. Of these, 118 (38.1%) endoscopies in 81 (40.1%) patients were performed for cancer screening purposes. Gastric cancer was found in 4 patients (2.0%); one of them presented with gastric cancer at the time of HIV diagnosis, and the other 3 patients were diagnosed with early gastric cancer on screening endoscopy, which was cured with endoscopic submucosal dissection or surgery. The prevalence of gastric cancer in screening endoscopies was 3.7%. Atrophic gastritis was a more common finding in screening endoscopies than in diagnostic endoscopies (P

Background Osteonecrosis of the femoral head (ONFH) is a disabling condition that often necessitates total hip arthroplasty (THA). Although ONFH occurs more frequently among patients with human immunodeficiency virus (HIV) than among the general population, there is little epidemiological information regarding ONFH in Korean patients with HIV. In the present study, we aimed to investigate the incidence and clinical features of ONFH among Korean patients with HIV. Materials and Methods In this retrospective study, we reviewed the medical records of 1,250 Korean patients with HIV treated from January 1990 to December 2019. A standardised data collection sheet was used to obtain clinical information. Imaging data were analysed by a radiologist in accordance with the 2019 revised version of the Association Research Circulation Osseous (ARCO) staging system for ONFH. Results Among the 1,250 included patients, 13 patients (1.04%; 3 women, 10 men) were diagnosed with ONFH. The overall incidence of ONFH was 1.29 per 1,000 person-years (PYs) (95% confidence interval [CI]: 0.7 – 2.4 per 1,000 PYs). Median age among the 13 patients with ONFH was 47 years (interquartile range [IQR]: 41 – 57 years). The median duration since HIV diagnosis was 4.8 years (IQR: 2.3 – 10.1 years). The median CD4 cell count at the time of ONFH diagnosis was 381 cells/ mm3 (IQR: 161 – 551 cells/mm3). At the initial diagnosis of ONFH, 83.3% of patients exhibited bilateral involvement. ARCO stage 3 or 4 osteonecrosis was observed in 83% of patients. Among 22 hips, stage 1 ONFH was noted in 2 (9.1%), stage 2 ONFH was noted in 7 (31.8%), stage 3 ONFH was noted in 9 (40.9%), and stage 4 ONFH was noted in 4 (18.2%). THA was eventually performed in 84.6% of patients. Five (38.5%) patients had a history of steroid use, 4 (30.8%) patients had a history of alcohol abuse and 10 (76.9%) were smokers. Eight (61.5%) patients had a history of acquired immune deficiency syndrome-defining illness, including 7 with tuberculosis and 1 with pneumocystis pneumonia. Nine patients (69.2%) had a nadir CD4 cell count

Background As human immunodeficiency virus (HIV) management has become more successful during the past years, the importance of non-AIDS-defining cancer such as gastric cancer has increased. Gastric cancer is the second most common cancer, and the third leading cause of cancer-related deaths in South Korea. Chronic inflammation of the gastric mucosa with Helicobacter pylori (H. pylori) is associated with gastric cancer, the highest incidence of which is observed in South Korea. The objective of this study was to evaluate the seroprevalence and risk factors of H. pylori infection in Korean HIV-infected patients. Methods In a hospital-based survey, HIV-infected patients attending Outpatient Department of Pusan National University Hospital were enrolled between October 2018 and January 2019. Socio-demographic information was evaluated using questionnaires, serological status of H. pylori infection was tested with commercial H. pylori serology kits (Helicobacter pylori IgG ELISA, IBL, Germany). Results A total of 302 patients were included in the study. Two hundred and Sixty-one patients (86.4%) were males and 41 (13.6%) were females. Their median age was 54 years (range, 23–81 years), median CD4+ count was 667 /μL (7–1,699 /μL). The overall seropositivity of H. pylori in HIV-infected patients was 30.1%. Age-specific seroprevalence was as follows: 20–29 years, 12.5%; 30–39 years, 15.6%; 40–49 years, 38.6%; 50–59 years, 36.2%; 60–69 years, 27.9%; and ≥70 years, 18.2%. A lower seroprevalence of H. pylori was observed among patients younger than 40 years; however, it was not significant (P = 0.063). The risk factors associated with H. pylori seropositivity were alcohol consumption [adjusted odds ratio (OR): 1.99, 95% confidence interval (CI): 1.17 to 3.39; P = 0.011] and CD4 cell count ≥350/μL (OR = 4.32; 95% CI 1.51–12.36; P = 0.006). Conclusion HIV-infected patients had a lower seroprevalence of H. pylori compared with general population (30.1% vs. 49.1%). Alcohol consumption and CD4 cell count ≥350/μL were significantly associated with H. pylori seropositivity. Disclosures All authors: No reported disclosures.

PURPOSE We performed a two-and-a-half year follow-up study of strategy factors in successful learning to predict academic achievements in medical education. METHODS Strategy factors in successful learning were identified using a content analysis of open-ended responses from 30 medical students who were ranked in the top 10 of their class. Core words were selected among their responses in each category and the frequency of the words were counted. Then, a factors survey was conducted among year 2 students, before the second semester. Finally, we performed an analysis to assess the association between the factors score and academic achievement for the same students 2.5 years later. RESULTS The core words were "planning and execution," "daily reviews" in the study schedule category; "focusing in class" and "taking notes" among class-related category; and "lecture notes," "previous exams or papers," and "textbooks" in the primary self-learning resources category. There were associations between the factors scores for study planning and execution, focusing in class, and taking notes and academic achievement, representing the second year second semester credit score, third year written exam scores and fourth year written and skill exam scores. Study planning was only one independent variable to predict fourth year summative written exam scores. CONCLUSION In a two-and-a-half year follow-up study, associations were founded between academic achievement and the factors scores for study planning and execution, focusing in class, and taking notes. Study planning as only one independent variable is useful for predicting fourth year summative written exam score.

Background The reports about fertility desire and pregnancy outcome among women infected with human immunodeficiency virus (HIV) in Korea are scarce. This study aimed to determine the changing trend in pregnancy incidence among women infected with HIV in Korea. Materials and methods We retrospectively reviewed the medical records of women infected with HIV visiting Pusan National University Hospital between January 1990 and October 2018. Results A total of 149 women with HIV infection visited the study hospital. Among them, 33 pregnancies in 24 (16.1%) women were identified. There were 17 live births (51.5%) and 13 abortions (39.4%), whereas 3 women (9.1%) were transferred to another hospital or were lost to follow-up. The number of live birth rose from 0 in 1990-1998 to 17 in 1999-2018. The proportion of repeated pregnancies after HIV diagnosis also increased steeply, from 14.3% in 1999-2008 to 50% in 2009-2018. However, the number of abortions also increased over time. There were 8 induced abortions, 7 (87.5%) of them were diagnosed with HIV infection during pregnancy and 3 (37.5%) were unplanned pregnancies. Eighteen babies, including 1 twin case, were born from 17 births. There was no mother-to-child HIV transmission in our study. Conclusion The number of pregnancies among women with HIV infection and repeated pregnancies after HIV diagnosis has been increasing in Korea, probably due to the desire of HIV patients to have more children. However, the number of abortions also increased, probably due to health concerns and uncertain pregnancy outcome.

Background The Korean Society of Infectious Diseases recommends non-mandatory vaccination of newly employed healthcare workers (HCWs) with 2 measles–mumps–rubella (MMR) vaccine doses. Here, we aimed to investigate the seroprevalence of mumps among HCWs exposed to index patients with mumps and the efficacy of MMR vaccination as postexposure prophylaxis (PEP) when a mumps outbreak was encountered among HCWs in a tertiary university hospital in Korea. Materials and Methods Four HCWs were diagnosed with mumps over a 4-day period in January 2016. Three were working at a dental clinic and one visited the clinic on the day of symptoms onset of the first patient. We investigated all HCWs who either worked in that dental clinic, visited the clinic, or being within 1.5 meter of the patients with mumps without wearing surgical masks. Seventy HCWs were exposed to 4 HCWs with mumps. We interviewed all the exposed HCWs to investigate mumps infection and MMR vaccination history; they were all tested for mumps IgG. Results Of the 70 exposed HCWs, 56 (80%) were females; the median age was 34 years (range 21–59 years) and 3 had a history of mumps infection. The vaccination status verification of mumps among the HCWs was unavailable. As for serologic testing, 54 (77.1%) were seropositive. Seropositivity rate for the mumps virus in males was significantly lower than that in females (50.0% vs. 83.9% respectively, P = 0.007). A lower seroprevalence of mumps was observed among HCWs aged ≥40 years than those aged 2 days. Thirty-four (62.9%) of 54 seropositive HCWs and 16 seronegative HCWs were administered MMR vaccines as PEP and following this, no additional cases of mumps were encountered during the maximum incubation period. Conclusion Of the exposed HCWs, 77.1% were mumps-seropositive. Seropositive rates differed according to factors such as age and sex. Eligible HCWs received a MMR vaccine as PEP and no additional mumps cases occurred during the incubation period. It was useful in our infection control activities during the mumps outbreak.

Background Active surveillance testing of carbapenem-resistant Enterobacteriaceae (AST-CRE) is recommended in high-risk settings, such as intensive care units (ICUs), to prevent CRE outbreaks or invasive infections. This study aimed to investigate the effects of AST-CRE by analyzing the prevalence and risk factors for acquiring CRE during the ICU care. Methods We conducted AST-CRE on rectal swabs of patients admitted to the ICU in the emergency room at a tertiary hospital in South Korea for 12.5 months. AST-CRE was performed upon admission and weekly thereafter. To assess the risk factors of acquiring AST-CRE during the admission period in adult patients, those colonized with CRE upon admission and aged Results A total of 810 patients were admitted during the study period. The acquisition rate and carbapenemase-producing CRE were 2.6% (21/810) and 42.9% (9/21), respectively. No invasive infection due to CRE was found. The most common species were Klebsiella pneumoniae (71.4%, 15/21), and eight KPC and one NDM genes were detected. In CRE-positive patients, in-hospital mortality and length of hospitalization were higher (P = 0.003) and longer (P < 0.001), respectively. Multivariate analyses showed that male gender (adjusted odds ratio [aOR] 8.0; 95% confidence interval [CI] 1.7–36.8), previous hospitalization in the last year (aOR 5.1; 95% CI 1.6–16.4), co-colonization with multidrug-resistant Acinetobacter species (aOR 18.3; 95% CI, 4.2–79.2) and extended-spectrum β-lactamase-producing bacteria (aOR 3.4; 95% CI, 1.1–10.9), and length of ICU admission until CRE detection for ≥10 days (aOR 6.5; 95% CI 2.2–19.2) were independently associated with CRE acquisition. Conclusion To prevent CRE outbreak or invasive infections, patients admitted in the ICU should be screened using AST-CRE. Disclosures All authors: No reported disclosures.

Background Group B streptococcus (GBS) has emerged as an important cause of invasive infection in nonpregnant adults. This study aimed to describe the clinical characteristics and risk factors associated with GBS bacteremia in nonpregnant adult patients in Korea. Methods Our retrospective study reviews the hospital records of nonpregnant adults, aged ≥18 years, with GBS bacteremia who attended the Pusan National University Hospital between January 1, 2008 and December 31, 2017. The presence of underlying diseases, such as cardiovascular diseases, diabetes mellitus, malignancy, liver disease and/or alcohol abuse and renal disease, as well as possible portals of entry of infection, was analyzed. Results During the period of 10 years, there were 79 patients with GBS bacteremia. In 47 episodes (59.5%), patients were aged 60 years or older and 43 (54.4%) episodes occurred in females. Their mean age was 61 years (range, 19–91 years) and 70 patients (88.6%) had underlying diseases. Cardiovascular diseases (n = 35, 44.3%) were the most common underlying conditions, and diabetes mellitus (n = 27, 34.2%) and nonhematologic malignancy (n = 27, 34.2%) were second. Genitourinary cancer composed nearly half of nonhematologic malignancy (n = 13, 48.1%). The other comorbid conditions were liver disease and/or alcohol abuse (n = 14, 17.7%), renal disease (n = 13, 16.5%) and hematologic malignancy (n = 7, 8.9%). The most common clinical syndrome was primary bacteremia (n = 31, 39.2%). The others were bone and joint infection (n = 15, 19.0%), urinary tract infection (n = 12, 15.2%), skin and soft-tissue infection (n = 7, 8.9%), infective endocarditis (n = 4, 5.1%), peritonitis (n = 4, 5.1%), and meningitis (n = 2, 2.5%). The overall mortality rate was 13.9%, all patients had at least one underlying disease. The mortality rate of primary bacteremia was significantly higher than those of bacteremia with focus (29.0% vs. 4.2%, respectively; P = 0.002). Hematologic malignancy, liver disease, and/or alcohol abuse and renal disease were significantly associated with the primary bacteremia. Conclusion GBS bacteremia is a significant problem in nonpregnant patients, especially primary bacteremia resulted in a high rate of mortality (29%). Hematologic malignancy, liver disease, and/or alcohol abuse and renal disease were significantly related to primary bacteremia occurrence. Disclosures All authors: No reported disclosures.

Caffeoylquinic acids -3,4-di-O-caffeoylquinic acid (1); 1,3,5-tri-O-caffeoylquinic acid (2); and 3,4,5-tri-O-caffeoylqunic acid (3)- were isolated from an acetone-soluble fraction of the aerial parts of Artemisia princes. Their structures were determined spectroscopically using 1D- and 2D-nuclear magnetic resonance (NMR) studies, as well as by comparing the NMR results with previously published structures. All the isolates were subjected to in vitro bioassays to evaluate their efficacy in inhibiting rat lens aldose reductase (RLAR) activity and the formation of advanced glycation end products (AGEs). We found 1,3,5-tri-O-caffeoylquinic acid (2) to be the most potent AGE inhibitor, and the concentration that resulted in 50% inhibition (IC50) was 22.18 ±1.46 mM, as compared to the aminoguanidine and chlorogenic acid controls, which had IC50 values of 1,093.11±10.95 and 117.63±0.20 mM, respectively. In the RLAR assay, the three caffeoylquinic acids were found to have IC50 values in the range of 1.78-2.40 μM, demonstrating a 5- to 10-fold greater efficacy in RLAR inhibition as compared to the quercetin control, which had an IC50 value of 17.91 μM.

The index case lived in the D rehabilitation facility in Gyeongsan-si and an additional epidemiological investigation was carried out there. The cases could not be questioned due to their mental handicaps. The teachers were interviewed instead. A patient case was defined as a resident with diarrhea more than one time a day from September 18 to September 26, 2008 or a resident with confirmed

Corni fructus has been used as a tonic, analgesic, and diuretic in Korean herbal medicine. The present investigation was undertaken to evaluate the antioxidative effect of corni fructus and its capacity to protect cells against oxidative damage. The radical scavenging activity of corni fructus extracts was measured using 1,1-diphenyl-2-picrylhydrazyl (DPPH), and the antioxidant activity was determined by measuring the peroxide value in a linoleic acid emulsion system. In addition, human umbilical vein endothelial cells (HUVECs) were treated with corni fructus extracts and incubated with H(2)O(2) to investigate protection against apoptosis induction. Both ethanol and water extracts of corni fructus produced higher DPPH radical scavenging activity than hexane, chloroform, and ethyl acetate extracts. Strong antioxidative activities of both water and ethanol extracts were observed in an emulsion system containing linoleic acid and phosphate buffer. The incubation of HUVECs with the addition of ethanol extract significantly decreased H(2)O(2)-initiated damage of endothelial cells, but the water extract did not. The pretreatment with ethanol extract, but not with water extract, significantly decreased apoptotic damage of the H(2)O(2)-treated HUVECs and kept the morphological normality. This study demonstrates that corni fructus is a potent antioxidant substance, and suggests that further investigation is needed to characterize the difference between extract types and to identify its antioxidant compounds.

A hydroxycyclopentadienyl ruthenium chloride, (η 5 -Ph 4 C 4 COH)(CO) 2 RuCl (2), is formed quantitatively by heating the Shvo complex, {[(η 5 -Ph 4 C 4 CO)] 2 H}-Ru 2 (CO) 4 (μ-H) (1), in chloroform containing a stoichiometric amount of ethanol. Alcohols are oxidized by the use of 1 or 2 as the catalyst in chloroform with sodium carbonate. Secondary alcohols and primary diols are oxidized selectively to give ketones and lactones, respectively, in excellent yields.

We have previously reported the existence of two different molecular species of protein methylase I (S-adenosylmethionine:protein-arginine N-methyltransferase, E.C. 2.1.1.23) in calf brain, one specific for myelin basic protein and the other for histone (Ghosh, S. K., Paik, W. K., and Kim, S. (1988) J. Biol. Chem. 263, 19024-19033). In the present study, however, we report that heterogeneous ribonucleoprotein particle protein A1 is most likely an in vivo substrate for the "histone-specific protein methylase I." The unmethylated recombinant protein A1 has been found to be a much superior methyl acceptor for the enzyme than histone with a Km value two orders of magnitude lower (0.19 microM) than that for histone (21 microM). Myelin basic protein, a specific inhibitor for histone protein methylase I, exhibited a lower IC50 for protein A1 methylation (IC50 = 33 microM) compared with histone methylation (IC50 = 220 microM) and competitively inhibited the former with a Ki value of 1.3 x 10(-6) M. The extent of inhibition of protein A1 and histone methylation by the polyclonal antibodies prepared against purified "histone protein methylase I" was identical. Maximally, 1.08-mol methyl groups were incorporated per mol of protein A1, which was 27-fold higher than that of histone (0.04 mol/mol of histone). HPLC analysis of the enzymatically methylated amino acid residues in protein A1 revealed the formation of NG-monomethylarginine and NG,NG-dimethylarginine. The ratio of NG,NG-dimethylarginine/NG-monomethylarginine increased as a function of incubation period; however, NG,N'G-dimethylarginine was not detectable. Proteolytic cleavage of the methyl-3H-labeled recombinant protein A1 by trypsin and Staphylococcus aureus V8 endoprotease indicated that protein A1 possesses multiple sites for methylation, one of which was identified as residue 194 arginine, which coincided with the in vivo methylation site.

Neurogenesis is regulated by several factors such as age, stress and pharmacological agents. We observed the effects of (-)-epigallocatechin-3-gallate (EGCG), a major catechin of green tea, on neurogenesis in mice. The animals were orally administered EGCG for 4 weeks. Brain sections were stained using a marker for cell proliferation (Ki67 and BrdU) and neuroblasts (doublecortin, DCX). In all groups, Ki67, BrdU and DCX immunoreaction were observed in the subgranular zone of the dentate gyrus. Oral administration of EGCG significantly increased the number of Ki67-, BrdU- and DCX-immunoreactive cells as well as BrdU/DCX-colabled cells in the subgranular zone when compared to those in the vehicle-treated group. These results indicate that oral administration of EGCG can enhance cell proliferation and increase the number of neuroblasts in mice hippocampal dentate gyrus.

A hydroxycyclopentadienyl ruthenium chloride, (η 5 -Ph 4 C 4 COH)(CO) 2 RuCl (2), is formed quantitatively by heating the Shvo complex, {[(η 5 -Ph 4 C 4 CO)] 2 H}-Ru 2 (CO) 4 (μ-H) (1), in chloroform containing a stoichiometric amount of ethanol. Alcohols are oxidized by the use of 1 or 2 as the catalyst in chloroform with sodium carbonate. Secondary alcohols and primary diols are oxidized selectively to give ketones and lactones, respectively, in excellent yields.