Interobserver diagnostic reproducibility in advanced-stage endometrial carcinoma

Background@#The accurate pathologic diagnosis and subtyping of high-grade endometrial carcinoma are often problematic, due to its atypical and overlapping histopathological features. @*Methods@#Three pathologists reviewed 21 surgically resected cases of advancedstage endometrial carcinoma. The primary diagnosis was based only on hematoxylin and eosin stained slides. When a discrepancy arose, a secondary diagnosis was made by additional review of immunohistochemical (IHC) stains. Finally, three pathologists discussed all cases and rendered a consensus diagnosis. @*Results@#The primary diagnoses were identical in 13/21 cases (62%). The secondary diagnosis based on the addition of IHC results was concordant in four of eight discrepant cases. Among four cases with discrepancies occurring in this step, two cases subsequently reached a consensus diagnosis after a thorough discussion between three reviewers. Next-generation sequencing (NGS) study was performed in two cases in which it was difficult to distinguish between serous carcinoma and endometrioid carcinoma. Based on the sequencing results, a final diagnosis of serous carcinoma was rendered. The overall kappa for concordance between the original and consensus diagnosis was 0.566 (moderate agreement). @*Conclusions@#We investigated stepwise changes in interobserver diagnostic reproducibility in advanced-stage endometrial carcinoma. We demonstrated the utility of IHC and NGS study results in the histopathological diagnosis of advanced-stage endometrial carcinoma.

Quality of Life in Patients with Osteoporotic Vertebral Compression Fractures

BACKGROUND: This study aimed to evaluate quality of life (QOL) using the EuroQOL-5 dimensions (EQ-5D) index and to examine factors affecting QOL in patients with an osteoporotic vertebral compression fracture (OVCF). METHODS: This ambispective study used a questionnaire interview. Patients over 50 years old with an OVCF at least 6 months previously were enrolled. Individual results were used to calculate the EQ-5D index. Statistical analysis was performed, and factors related to QOL were examined. RESULTS: Of 196 patients in the study, 84.2% were female, with an average age of 72.7 years. There were 66 (33.7%) patients with multilevel fractures. Conservative management was used in 75.0% of patients, and 56.1% received anti-osteoporosis treatment. The mean EQ-5D index was 0.737±0.221 and was significantly correlated with the Oswestry disability index score (correlation coefficient −0.807, P<0.001). The EQ-5D index was significantly correlated with age (Spearman's rho=−2.0, P=0.005), treatment method (P=0.005), and history of fracture (P=0.044) on univariate analysis and with conservative treatment (P<0.001) and osteoporotic treatment (P=0.017) on multivariate analysis. CONCLUSIONS: OVCF markedly lowers QOL in several dimensions for up to 12 months, even in patients who have healed. Treatment of osteoporosis and conservative treatment methods affect QOL and should be considered in OVCF management.

Hip Screening in Infants Presenting with Asymmetricity of Lower Extremity / 대한정형외과학회잡지

PURPOSE: This study aimed to investigate the clinical features of congenital postural deformities and lower extremity asymmetry with respect to the presence of developmental dysplasia of the hip (DDH) in infants with a discrepancy of the limb length referred for suspected DDH. MATERIALS AND METHODS: We retrospectively reviewed the medical records and radiographs of 150 infants who visited Korea University Anam Hospital Orthopedic Clinic for suspected DDH between March 2013 and March 2015. RESULTS: There were greater numbers of infants with a shorter lower extremity on the left side (n=86, 57.3%) than the right. Plagiocephaly was present in 62 infants and trunk curvature in 124 infants (82.7%). Pelvic tilting—indirectly assessed by a skewed direction of the external genitalia in female infants—was present in 62 infants (63.3%). None of the 139 infants with normal physical examination of the hip were diagnosed with DDH. Of those 11 infants with abnormal findings from the hip physical examination, a total of 6 infants were diagnosed with DDH. CONCLUSION: Regardless of the associated findings of congenital postural deformation, all infants diagnosed with DDH had abnormal findings from the physical examination of the hip joint. Thus, we conclude that the hip examination is important as the primary clinical screening in aiding the diagnosis of DDH.

A study on oral health knowledge and the need for oral health education among industrial workers / 대한구강보건학회지

OBJECTIVES: This study aimed to investigate the correlation between oral health behaviors of workers by examining the oral health awareness and the need for oral health education. METHODS: After the institutional review board approval, we surveyed industrial workers in Seoul, Gwangju, Changwon, and Goksung, in Korea, from July 19 to August 29, 2016. The final questionnaires (287 in total) were assessed using the SPSS 24.0 software for Windows (SPSS Inc. Chicago, IL, USA). The data were analyzed using frequency analysis, average, standard deviation, t-test, and the Pearson's correlation coefficient. RESULTS: Through the response of “yes” for the question, “oral health education experience,” we can see the respondents have high level of interest (P<0.001). And through the response of “yes” for the question, “Periodic oral Examination” and “regular scaling” and “oral care product use” we can see the respondents have high level of interest (P<0.001) and high importance (P<0.001), there was a statistically significant difference. On analyzing the correlations between workers, there was positive correlation oral health ‘Interest’ and ‘Importance’ (r=0.598, P<0.001). Of the 287 participants, 80.1% indicated that they did not receive any previous oral health education, while 85.4% indicated a willingness to attend oral health education programs in the future. Of the 80.1% of participants with no prior oral health education, 60.0% indicated lack of oral health education because of few opportunities to participate in such programs. They most prefer “Oral Hygiene Management” 64.8% for education contents and choose “Direct-education by inviting Expert” as the best education method 75.6%. CONCLUSIONS: It is necessary to develop oral health education programs suitable for the industrial field characteristics for people in workplace, and to enhance and expand oral health education services in the workplace in order to maintain interest in oral health.

Acute decompensated heart failure and acute kidney injury due to bilateral renal artery stenosis / 영남의대학술지

Atherosclerotic renal artery stenosis (RAS) may result in hypertension, azotemia, and acute pulmonary edema. We report on a renal angioplasty with stent placement for bilateral RAS in a patient with acute decompensated heart failure and acute kidney injury. A 67-year-old female patient was admitted to our hospital with acute shortness of breath and generalized edema. Echocardiography showed left ventricular wall motion abnormality and the follow up electrocardiography showed T wave inversion in the precordial leads. We performed a coronary angiography to differentiate ischemic heart disease from non-cardiac origin for the cause of the heart failure. The coronary angiography showed no significant luminal narrowing, but bilateral RAS was confirmed on the renal artery angiography, therefore, we performed renal artery revascularization. After the procedure, the pulmonary edema was improved and the serum creatinine was decreased. Two weeks later, an echocardiography showed improvement of the left ventricular systolic function.

The PTPRD (Protein Tyrosine Phosphatase Receptor Type Delta) Gene Polymorphism and Antipsychotic-Induced Restless Legs Syndrome in Schizophrenia / 대한정신분열병학회지

OBJECTIVES: The previous genome-wide association studies have revealed several candidate genes for restless legs syndrome (RLS). The PTPRD (protein tyrosine phosphatase receptor type delta) gene is one of the candidate genes for RLS. The occurrence of antipsychotic-related RLS could also be attributable to differences in genetic susceptibility. This study aimed to investigate whether PTPRD polymorphism is associated with antipsychotic-related RLS in schizophrenia. METHODS: We assessed symptoms of antipsychotic-induced RLS in 190 Korean schizophrenic patients and divided the subjects into two groups according to the International Restless Legs Syndrome Study Group diagnostic criteria : (i) subjects that met all of the criteria (n=44) and (ii) the remaining subjects who were not considered to be RLS patients (n=146). PTPRD rs462664 was genotyped by PCR in 190 individuals. The chi2-test was performed to compare differences between two groups. RESULTS: The frequencies of genotype (chi2=1.31, p=0.519) of the PTPRD rs462664 did not differ significantly between schizophrenic patients with and without RLS. The difference of allele frequencies (chi2=1.30, p=0.25) of the PTPRD rs462664 between the schizophrenic patients with and without RLS were not significant. CONCLUSION: These results suggest that PTPRD gene polymorphism does not play a major role in susceptibility to antipsychotic-related RLS in schizophrenia. This finding suggests that antipsychotic-induced RLS may have a different pathogenesis compared to primary RLS.

A Case of Diffuse Alveolar Hemorrhage Following Abciximab Therapy / 대한내과학회지

Platelets play an important role in the development of acute coronary syndrome. Platelet-inhibiting drugs, such as glycoprotein IIb/IIIa inhibitors, can be beneficial when they are administered at the time of primary percutaneous coronary intervention for acute coronary syndrome. Although an increased risk for bleeding complications is well recognized, the risk associated with diffuse alveolar hemorrhage is much less reported. We report a case of diffuse alveolar hemorrhage after using abciximab.

Relationship between Antiphospholipid Antibodies and Major Adverse Cardiovascular Events after Drug-Eluting Stent Implantation in Patients with Acute Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: Several studies have reported an association between antiphospholipid antibodies (APA) and major adverse cardiovascular events (MACE) following acute myocardial infarction (AMI). However, the relationship between APA and the prognosis after drug-eluting stent (DES) implantation in patients with AMI is not known. METHODS: Thus, we investigated the relationship between the incidence of MACE and APA levels in patients with AMI who underwent successful DES implantation. RESULTS: Of 182 patients, 78 (42.9%) tested positive for APA. Lupus anticoagulant was positive in 37.6% (68 of 181) patients, anticardiolipin antibody IgM was positive in 8.3% (15 of 180), and anticardiolipin antibody IgG was positive in 1.7% (3 of 180) patients. At follow up, a MACE had occurred in 11 (14.1%) patients in the APA-positive group and in seven (6.7%) patients in the APA-negative group (p = 0.099). CONCLUSIONS: No significant association was found between the incidence of MACE and the presence of APA in patients with AMI who underwent successful DES implantation.

Comparison of Functional Gene Annotation of Toxascaris leonina and Toxocara canis using CLC Genomics Workbench

The ascarids, Toxocara canis and Toxascaris leonina, are probably the most common gastrointestinal helminths encountered in dogs. In order to understand biological differences of 2 ascarids, we analyzed gene expression profiles of female adults of T. canis and T. leonina using CLC Genomics Workbench, and the results were compared with those of free-living nematode Caenorhabditis elegans. A total of 2,880 and 7,949 ESTs were collected from T. leonina and T. canis, respectively. The length of ESTs ranged from 106 to 4,637 bp with an average insert size of 820 bp. Overall, our results showed that most functional gene annotations of 2 ascarids were quite similar to each other in 3 major categories, i.e., cellular component, biological process, and molecular function. Although some different transcript expression categories were found, the distance was short and it was not enough to explain their different lifestyles. However, we found distinguished transcript differences between ascarid parasites and free-living nematodes. Understanding evolutionary genetic changes might be helpful for studies of the lifestyle and evolution of parasites.

Asymptomatic Isolate Tricuspid Regurgitation with Chordae Tendineae Rupture Caused by Blunt Chest Injury / 영남의대학술지

The incidence and importance of tricuspid valve regurgitation after a blunt chest injury has risen with the increase in the number of automobile accidents and steering wheel traumas. This kind of injury has been reported more frequently in the last decade because of the better diagnostic procedures and understanding of the pathology. However, tricuspid valve regurgitation following a blunt chest injury can still be easily missed because most patients do not show symptoms at the time of the trauma. A 55-year-old male patient presented himself at our facility after suffering a chest injury from an automobile accident. His transthoracic echocardiography (TTE) revealed severe tricuspid valve regurgitation due to the prolapse of his anterior valve leaflet. We report a case of asymptomatic tricuspid regurgitation that developed after a blunt chest injury.