Reduction of mycoplasmal lesions and clinical signs by vaccination against Mycoplasma hyorhinis.

Porcine mycoplasmal pneumonia is a significant disease problem in the swine industry. The causative agents include Mycoplasma hyopneumoniae and Mycoplasma hyorhinis. M. hyopneumoniae is the major pathogen contributing to the porcine respiratory disease complex, but is difficult to isolate from the respiratory tract and tonsils, whereas M. hyorhinis is not. Although M. hyorhinis is commonly detected in the lungs, the role of M. hyorhinis as a cause of pneumonia remains unclear. Current vaccines for porcine mycoplasmal pneumonia only include M. hyopneumoniae, not M. hyorhinis. M. hyopneumoniae vaccines are widely used, but disease still occurs because of poor vaccine efficacy and possibly the presence of M. hyorhinis. In this study, an inactivated vaccine containing a mixture of M. hyorhinis and M. hyopneumoniae was generated and evaluated for safety, immunogenicity, and protective efficacy against challenge with M. hyorhinis in pigs. The inactivated vaccine induced an antibody response and reduced pneumonic lesions in the lungs and tracheas compared with the non-vaccinated group.

Mycoplasma hyorhinis is a potential pathogen of porcine respiratory disease complex that aggravates pneumonia caused by porcine reproductive and respiratory syndrome virus.

The porcine respiratory disease complex (PRDC) caused by numerous bacterial and viral agents has a great impact on pig industry worldwide. Although Mycoplasma hyorhinis (Mhr) has been frequently isolated from lung lesions from pigs with PRDC, the pathological importance of Mhr may have been underestimated. In this study, 383 serum samples obtained from seven herds with a history of PRDC were tested for specific antibodies to Mhr, Mycoplasma hyopneumoniae (Mhp), and porcine reproductive and respiratory syndrome virus (PRRSV). Seropositive rates of PRRSV were significantly correlated with those of Mhr (correlation coefficient, 0.862; P-value, 0.013), but not with those of Mhp (correlation coefficient, -0.555; P-value, 0.196). In vivo experiments demonstrated that pigs co-infected with Mhr and PRRSV induced more severe lung lesions than pigs infected with Mhr or PRRSV alone. These findings suggest that Mhr is closely associated with pneumonia caused by PRRSV and provide important information on Mhr pathogenesis within PRDC. Therefore, effective PRDC control strategies should also consider the potential impact of Mhr in the pathogenesis of PRDC.

Establishing a Population-Based HLA-Antibody Panel for Flow Cytometric Monitoring of Chimerism in HLA-Haploidentical Stem Cell Transplantation.

Determining the chimerism in stem cell transplantation (SCT) is important in the monitoring of engraftment. Conventional monitoring methods such as short tandem repeat polymerase chain reaction (STR-PCR) are labor intensive and difficult in showing the dynamics of cell subpopulations. In HLA-haploidentical SCT, flow cytometric analysis using anti-HLA antibody for the mismatched HLA can be useful in observing changes of cell subpopulations and determining chimerism. We designed a specific panel of HLA antibody reagents for the Korean population, and verified its clinical application in flow cytometric monitoring of chimerism after haploidentical stem cell transplantation. A total of 12 anti-HLA-A, -B-antibodies were selected, which could cover 82.5% of HLA-A and 16.5% of HLA-B in Korean population. This HLA panel distinguished donor and recipient cells in 22 of 23 HLA-haploidentical SCT cases. In one case, the patient had HLA-A*02/A*24, B*48/B*61 while the donor had HLA-A*02/A*33, B*44/B*48. The donor type HLA-B*44(+) and CD3(+) T cells, and HLA-B*44(+) and CD56(+) NK cells were seen at day 14 and day 8, respectively. Increased HLA-B*44(+) cells throughout the study period indicated the engraftment of donor stem cells. We were able to design a population specific panel of HLA-antibodies, and verified that flow cytometric analysis using HLA antibody for the detection of chimerism in HLA-haploidentical SCT was a simple and sensitive monitoring technique. This method allowed us to observe the dynamic changes in cell subpopulations after HLA-haploidentical SCT. Flow cytometric analysis can be considered as a strong tool for the monitoring of engraftment in HLA-haploidentical SCT.

Description of a Mobile-based Electronic Informed Consent System Development.

Seoul National University Hospital constructed and implemented a computer-based informed consent system in December 2011. As of 2013, 30% of the informed consents were still filled out manually on paper. Patients and medical staff continuously suggested the implementation of a system for electronic informed consent using portable devices. Therefore, a mobile-based system for electronic informed consent was developed in 2013 to prevent the issues that arise with computer-based systems and paper informed consent. The rate of filling out electronic informed consent increased from 69% to 95% following the implementation of the mobile-based electronic informed consent. This construction of a mobile-based electronic informed consent system would be a good reference point for the development of a mobile-based Electronic Medical Record and for various mobile system environments in medical institutions.

Development of an early detection and monitoring system for deteriorating patients.

A number of methods of preventing cardiopulmonary arrest are currently in use. One such method is the alert response system developed by Seoul National University Children's Hospital, which is an early detection and monitoring system for deteriorating patients who are at risk of cardiopulmonary arrest. This system offers an effective means of detecting early warning signs and monitoring deteriorating patients, and its application can reduce rates of cardiopulmonary arrest.

Efficacy of a commercial live attenuated Lawsonia intracellularis vaccine in a large scale field trial in Korea.

PURPOSE: Porcine proliferative enteropathy (PPE) is known as one of the most important risk factors causing economic losses in swine industry worldwide. This study was conducted to evaluate the efficacy of a commercial oral attenuated Lawsonia intracellularis vaccine (Enterisol Ileitis) against PPE under a commercial pig farm condition in Korea. MATERIALS AND METHODS: Thirty two-day-old 672 piglets were randomly allocated into vaccinated and control groups. All piglets in the vaccinated group were inoculated with a commercial attenuated L. intracellularis vaccine as following the manufacturer's instruction. Body weights of all pigs in both groups were measured on the vaccination day and 6, 14, and 20 weeks post vaccination and an average daily weight gain (ADWG) was calculated. Health status was observed biweekly during the whole trial. RESULTS: The vaccinated group showed significantly higher body weight (p<0.05) and ADWG (p<0.05) than those of the control group. The vaccinated group had significantly reduced impairments in activity, growth, defecation frequency, and stool hardness (p<0.05). Additional health benefits and improved weight gain by the vaccination produced a 4.2:1 return of investment, and the higher gross margin was $4.80 per pig. CONCLUSION: Our finding suggests that the L. intracellularis vaccine program has effects on the substantial health and economic benefits in the Korean swine industry.

Case study: analysis of end-user requests on electronic medical record and computerized physician order entry system of Seoul National University Hospital in Korea.

Seoul National University Hospital (SNUH) in Korea has utilized the full Electronic Medical Record (EMR) system since October 2004. Unlike other countries, most EMR systems in Korean teaching and general hospitals are in-house development systems. Therefore, we can actively respond to user requests on EMR. Here, based on 5 years of experience in EMR system operation, we analyzed 2,339 SNUH EMR user requests from 2006 to 2008 for improvement of EMR system operation and management. We classify user requests into 9 criteria based on guidelines from the SNUH medical information management team. In conclusion, the most common requests (73%) are for improvement of improving quality of care. However, requests associated with hospital enterprise, public policy, and customer service are gradually increased every year. Therefore, we suggest that suitable EMR management criteria are necessary for reliable EMR operation and management.

Implementation of Consolidated HIS: Improving Quality and Efficiency of Healthcare.

OBJECTIVES: Adoption of hospital information systems offers distinctive advantages in healthcare delivery. First, implementation of consolidated hospital information system in Seoul National University Hospital led to significant improvements in quality of healthcare and efficiency of hospital management. METHODS: THE HOSPITAL INFORMATION SYSTEM IN SEOUL NATIONAL UNIVERSITY HOSPITAL CONSISTS OF COMPONENT APPLICATIONS: clinical information systems, clinical research support systems, administrative information systems, management information systems, education support systems, and referral systems that operate to generate utmost performance when delivering healthcare services. RESULTS: Clinical information systems, which consist of such applications as electronic medical records, picture archiving and communication systems, primarily support clinical activities. Clinical research support system provides valuable resources supporting various aspects of clinical activities, ranging from management of clinical laboratory tests to establishing care-giving procedures. CONCLUSIONS: Seoul National University Hospital strives to move its hospital information system to a whole new level, which enables customized healthcare service and fulfills individual requirements. The current information strategy is being formulated as an initial step of development, promoting the establishment of next-generation hospital information system.