Effect of Phoxilium on prognostic predictors in patients undergoing continuous venovenous hemodiafiltration

Background@#Phosphorus-containing dialysis solution is used to prevent hypophosphatemia in patients undergoing continuous venovenous hemodiafiltration (CVVHDF). This study evaluated the effect of phosphorus-containing dialysis solution on mortality in patients undergoing CVVHDF based on changes in phosphorus and red cell distribution width-coefficient of variation (RDW-CV) levels. @*Methods@#We included 272 patients with acute kidney injury (AKI) who underwent CVVHDF at the medical intensive care unit from 2017 to 2019 and classified them according to Phoxilium (Baxter Healthcare Ltd.), as a phosphorus-containing dialysis solution, use within 48 hours after CVVHDF initiation. Clinical data were collected at baseline and 48 hours after CVVHDF initiation. The primary outcome was all-cause mortality during the follow-up period. @*Results@#The non-Phoxilium (NP) group had higher phosphorus and lower RDW-CV levels than the Phoxilium (P) group (phosphorus, 7.3 ± 4.3 vs. 5.0 ± 2.8 mg/dL; RDW-CV, 14.6 ± 1.9 vs. 15.7 ± 2.6%; all p 0 mg/dL vs. 0% vs. 0% vs. >–0.2% and <0%; HR, 2.65; 95% CI, 1.12–6.24; p = 0.03), while an increase in delta phosphorus was not. @*Conclusion@#In patients with AKI undergoing CVVHDF, the risk factors for all-cause mortality differed according to the initial phosphorus levels and use of Phoxilium.

Acute Myocarditis in Children: a 10-year Nationwide Study (2007–2016) based on the Health Insurance Review and Assessment Service Database in Korea

Background and Objectives@#We performed a nationwide study to assess the incidence, treatment patterns, and outcomes of acute myocarditis in Korean children. @*Methods@#The nationwide incidence, treatment patterns, and outcomes of acute myocarditis in Korean children were assessed using data between 2007 and 2016 from the Health Insurance Review and Assessment database. @*Results@#We investigated 1,627 children during the study period. The overall incidence of acute myocarditis was 1.4 per 100,000 children in 2007 and 2.1 per 100,000 children in 2016, which indicates a significant increase in the trend over time. A bimodal age distribution was observed with a larger peak in infancy and a smaller peak in the mid-teenage years. No sex difference was observed in the incidence rate of acute myocarditis in children aged ≤5 years (373 boys vs. 366 girls); however, the incidence rate of acute myocarditis in adolescents aged ≥13 years showed significant male preponderance (482 boys vs. 152 girls). Acute fulminant myocarditis occurred in 371 children (22.8%) who needed extracorporeal membrane oxygenation and/or mechanical ventilator support. Of the 371 children with acute fulminant myocarditis, 258 (69.5%) survived. The survival rate of children with acute fulminant myocarditis remained nearly identical over the 10-year study period. @*Conclusions@#This was the first nationwide epidemiological study to investigate acute myocarditis in Korean children. In our view, this study would help clinicians in decisionmaking and planning for optimal management of acute myocarditis in children.

The Effectiveness of Multidisciplinary Team-Based Education in the Management of Type 2 Diabetes / 임상당뇨병

BACKGROUND: Although clinicians, nurse specialists, pharmacists, and nutritionists expend significant time and resources in optimizing care for patients with diabetes, the effectiveness of integrated diabetes care team approach remains unclear. We assessed the effects of a multidisciplinary team care educational intervention on glycated hemoglobin (HbA1c) levels among diabetes patients. METHODS: We conducted a matched case-control study in Korean patients with type 2 diabetes, comparing the propensity scores pertaining to the effectiveness in reducing HbA1c levels between a group receiving an educational intervention and a control group. We included 40 pairs of patients hospitalized between June 2014 and September 2016. HbA1c values measured at baseline, 3 months, and 6 months were compared between the two groups. RESULTS: The educated group showed an improvement in HbA1c levels compared to the control group at 3 months (6.3 ± 2.3% vs. 9.5 ± 4.0%; P = 0.020) and at 6 months (7.5 ± 1.5% vs. 9.6 ± 3.0%; P = 0.106). There was a significant difference in the change in mean HbA1c from baseline to 3 months between the two groups (−35.7 ± 26.1% vs. −9.1 ± 20.5%; P = 0.013). CONCLUSION: A multidisciplinary team care education intervention was advantageous for improving glucose control in patients with type 2 diabetes, and may help to optimize glycemic control in clinical practice.

Agreement between Parents and Teachers on School Children's Emotional/Behavioral Problems

OBJECTIVES: In assessing behavioral/emotional problems in school-aged children, the importance of multi-informant reporting has been well documented. However, in clinical settings obtaining multiple informants' opinions has proven difficult. For that reason, we researched the agreement and predictive validity of the Child Problem-Behavior Screening Questionnaire (CPSQ) in order to reveal how accurate parents' assessments reflected teachers' opinions. METHODS: We conducted the first screening for second- and third-grade children from 3 elementary schools in Seoul from 2003 to 2007 using the CPSQ. There were 1178 children included in the analysis. We then administered the Korean version of the Child Behavior Checklist (K-CBCL) as a second screening tool and subsequently, the ADHD Diagnostic System (ADS) and the Korean Educational Development Institute version of the Wechsler Intelligence Scale for Children (KEDI-WISC) was administered by a psychiatrist. We examined each item on the CPSQ and the subscale's agreement between parent and teacher as well as the predictive validity of the CPSQ in children diagnosed with emotional/behavioral problems. RESULTS: The agreement rates between parents and teachers appeared high for questions 18 (0.433), 1 (0.385), and 2 (0.325). Among the subscales, a relatively high correlation was found for externalizing problems, attention deficit hyperactivity disorder, and cognitive problems. For all diagnosed children, their parents revealed a higher sensitivity and lower specificity than teachers. CONCLUSION: From these results, we confirmed that the CPSQ can be useful for sorting out externalizing and cognitive problems. There is a need for further study, however, with a larger sample size.

Development of an Algorithm for the Prevention and Management of Pressure Ulcers / 성인간호학회지

PURPOSE: The purpose of this study was to develop an algorithm for preventing and managing of pressure ulcer and to verify the its appropriateness. METHODS: The first step was development of a pre-algorithm through a literature review and expert opinion. The second step was to establish content validity by submitting the algorithm questionnaires about the content to 12 experts. The third step was the revision of the algorithm. The fourth and last step was to establish the clinical validity of the algorithm with 25 experienced nurses. RESULTS: For the ease of the practitioner the algorithm for prevention and the management of pressure ulcers was confined to one page depicting the main algorithm pathway and seven stepwise guidelines. The guidelines included skin care of pressure ulcer prevention, mechanical loading care, support surface care , reposition care of pressure ulcer, and Stages II, III and IV explanations along with debridement/wound irrigation and infection control. Most of all algorithm courses chosen more than 80% of agreement by expert index of content validity. The usefulness, appropriateness, and convenience of the algorithm were demonstrated through clinical validity with intensive care unit and ward nurses. CONCLUSION: The algorithm will improve the quality of pressure ulcer nursing care as it provides a model for decision making for clinical nurses as well as providing consistent and integrated nursing care for patients with pressure ulcer throughout an institution.

Relationship Between Serum Biochemical Markers of Myocardial Fibrosis and Diastolic Function at Rest and With Exercise in Hypertrophic Cardiomyopathy

BACKGROUND AND OBJECTIVES: Recent studies have demonstrated the usefulness of biochemical markers of collagen turnover as markers of myocardial fibrosis in various diseases. In this study, we hypothesized that increased collagen markers in patients with hypertrophic cardiomyopathy (HCM) were correlated with diastolic function at rest and diastolic functional reserve during exercise. SUBJECTS AND METHODS: Thirty-six patients with HCM and 21 controls with normal left ventricular thickness were studied. Mitral septal annular velocities and mitral inflow velocities were measured at rest and during graded supine bicycle exercise (25 W, 3-minute increments) for the assessment of diastolic function at rest and during exercise. By radioimmunoassay, a byproduct of collagen III synthesis (PIIINP) and peptides resulting from collagen I synthesis (PINP) and degradation (ICTP) were measured. The patients with HCM were divided into two groups according to the median value of the PINP/ICTP ratio in the group. RESULTS: At rest, the mitral annular early diastolic velocity (E') was lower and the E/E' was higher in the patients with HCM with high a PINP/ICTP ratio compared with patients with HCM with a low PINP/ICTP ratio and controls (p<0.001, p=0.012). With exercise, the Doppler parameters were increased in all groups, but there was no significant difference in the change in E' and E/E' during exercise according to collagen turnover markers. CONCLUSION: A higher PINP/ICTP ratio was associated with resting diastolic dysfunction in patients with HCM; however, there was no relationship with augmented diastolic dysfunction during exercise. We suggest that the type I collagen synthesis-to-degradation ratio is a useful marker of resting diastolic function in patients with HCM.

Noninvasively-determined Diastolic Stiffness is Abnormal during Exercise, but not at Rest, in Patients with Apical Hypertrophic Cardiomyopathy

BACKGROUDN: The ratio of mitral inflow (E) and annular velocity (E') to stroke volume (E/E'/SV) has been used as an index of diastolic elastance (Ed). However, its change during exercise has not been evaluated. We hypothesized that Ed values obtained during exercise would be abnormal in patients with apical hypertrophic cardiomyopathy (ApHCM). METHODS: Ed was measured at rest and during graded supine bicycle exercise (25 Watts, 3 minute increments) in 15 patients with ApHCM (12 male; mean age, 57 years) and in 15 age- and gender-matched control subjects. RESULTS: Ed was not significantly different at rest and during 25 W of exercise. However, Ed was significantly higher at 50 W of exercise in patients with ApHCM compared to control subjects (0.21+/-0.05 vs. 0.15+/-0.04 cm/s, p=0.0059). There was significant positive correlation between the magnitude of change in proBNP levels during exercise and the change of Ed from rest to 50 W of exercise (r2=0.69, p<0.0001). CONCLUSION: Noninvasively-determined Ed was similar at rest and during mild exercise between patients with ApHCM and control subjects. However, Ed was significantly higher during moderate exercise in ApHCM patients, suggesting a dynamic change in LV stiffness during exercise in these patients.

Noninvasively-determined Diastolic Stiffness is Abnormal during Exercise, but not at Rest, in Patients with Apical Hypertrophic Cardiomyopathy

BACKGROUDN: The ratio of mitral inflow (E) and annular velocity (E') to stroke volume (E/E'/SV) has been used as an index of diastolic elastance (Ed). However, its change during exercise has not been evaluated. We hypothesized that Ed values obtained during exercise would be abnormal in patients with apical hypertrophic cardiomyopathy (ApHCM). METHODS: Ed was measured at rest and during graded supine bicycle exercise (25 Watts, 3 minute increments) in 15 patients with ApHCM (12 male; mean age, 57 years) and in 15 age- and gender-matched control subjects. RESULTS: Ed was not significantly different at rest and during 25 W of exercise. However, Ed was significantly higher at 50 W of exercise in patients with ApHCM compared to control subjects (0.21+/-0.05 vs. 0.15+/-0.04 cm/s, p=0.0059). There was significant positive correlation between the magnitude of change in proBNP levels during exercise and the change of Ed from rest to 50 W of exercise (r2=0.69, p<0.0001). CONCLUSION: Noninvasively-determined Ed was similar at rest and during mild exercise between patients with ApHCM and control subjects. However, Ed was significantly higher during moderate exercise in ApHCM patients, suggesting a dynamic change in LV stiffness during exercise in these patients.

Maternal Serum and Amniotic Fluid Inhibin A Levels in Women who Subsequently Develop Severe Preeclampsia

The purpose of this study was to evaluate whether maternal serum (MS) and amniotic fluid (AF) inhibin A levels are elevated in patients who subsequently develop severe preecalmpsia, and to investigate the correlation between MS and AF inhibin A levels in the second trimester. The study included 40 patients who subsequently developed severe preecalmpsia and 80 normal pregnant women. Inhibin A levels in MS and AF were measured with enzyme-linked immunosorbent assay (ELISA). The MS and AF inhibin A levels in patients who developed severe preeclampsia were significantly higher than those in the control group (both for p<0.001). There was a positive correlation between MS and AF inhibin A levels in patients who developed severe preeclampsia (r=0.397, p=0.011), but not in the control group (r=0.185, p=0.126). The best cutoff values of MS and AF inhibin A levels for the prediction of severe preeclampsia were 427 pg/mL and 599 pg/mL, respectively; the estimated ORs that were associated with these cut-off values were 9.95 (95% CI 3.8-25.9, p<0.001) and 6.0 (95% CI 2.3-15.8, p<0.001). An elevated level of inhibin A in MS and AF at the time of second trimester amniocentesis may be a risk factor for the subsequent development of severe preeclampsia.

Role of N-terminal Hydrophilic Amino Acids in Molecular Translocation of CTLA-4 to Cell Surface

BACKGROUND: This study was aimed to differentiate two forms of CTLA-4 (CD152) in activated peripheral blood lymphocyte and clarify the mechanism how cytoplasmic form of this molecule is targeted to cell surface. METHODS: For this purpose we generated 2 different anti-human CD152 peptide antibodies and 5 different N'-terminal deletion mutant CTLA4Ig fusion proteins and carried out a series of Western blot and ELISA analyses. Antipeptide antibodies made in this study were anti-CTLA4pB and anti- CTLA4pN. The former recognized a region on extracellular single V-like domain and the latter recognized N'-terminal sequence of leader domain of human CD152. RESULTS: In Western blot, the former antibody recognized recombinant human CTLA4Ig fusion protein as an antigen. And this recognition was completely blocked by preincubating antipeptide antibody with the peptide used for the antibody generation at the peptide concentration of 200 ug/ml. These antibodies were recognized human CD152 as a cytoplasmic sequestered- and a membrane bound- forms in phytohemagglutinin (PHA)- stimulated peripheral blood lymphocyte (PBL). These two forms of CD152 were further differentiated by using anti-CTLA4pN and anti-CTLA4pB antibodies such that former recognized cytosolic form only while latter recognized both cytoplasmic- and membrane- forms of this molecule. Furthermore, in a transfection expression study of 5 different N'-terminal deletion mutant CTLA4Ig, mutated proteins were secreted out from transfected cell surface only when more than 6 amino acids from N'-terminal were deleted. CONCLUSION: Our results implies that cytosolic form of CTLA-4 has leader sequence while membrane form of this molecule does not. And also suggested is that at least N'-terminal 6 amino acid residues of human CTLA-4 are required for regulation of targeting this molecule from cytosolic- to membrane- area of activated human peripheral blood T lymphocyte.

One-year Follow-up of the Hospitalized Schizophrenic Patients Treated with Risperidone or Olanzapine: Aspects in Cost Economy / 신경정신의학

OBJECTIVES: This study was conducted to access the cost-effectiveness of risperidone or olanzapine in a subset of patients with schizophrenia. METHODS: Two schizophrenia patient groups who were with risperidone(n=17) or olanzapine(n=20) were compared with each other in total medical cost, average daily cost of antipsychotics, discharge rate, drop-out rate, readmission rate and extropyramidal side effect(EPS). RESULTS: The average daily costs of risperidone and olanzapine treated groups were \9,778 and \9,536 in admission, and \2,219 and \5,118 in patients one year after discharge respectively. Risperidone group showed higher rate of EPS than olanzapine group. There was no significant difference in discharge or drop-out rate. CONCLUSIONS: Olanzapine group had higher total daily medical cost and daily medication cost, while risperidone group showed higher readmission and EPS rate.

Analysis of Chromosome-specific Aneusomy in Breast Tumor by Using Fluorescence in Situ Hybridization

PURPOSE: Several studies have used FISH (fluorescence in situ hybridization) to analyze aneuploids in various solid tumors. FISH, using chromosome-specific, alpha-stellite DNA probes, can be used to detect aneusomy in interphase and/or metaphase cells. The aims of this study were to compare the FISH cen tromere signals from benign breast tumors and to those from breast cancers and to evaluate the clinico pathologic parameters and the aneusomic patterns involving chromosomes 1, 11, and 17 in breast cancers. METHODS: FISH was performed on touch preparations from 15 benign breast-tumor and 29 breast-cancer specimens. The frequency of aneusomy, measured by nondisomy, was determined for chromosomes 1, 11, and 17 through the use of chromosome-specific alpha-stellite DNA probes. The frequency of chromosome- specific aneusomy was then correlated with clinicopathologic parameters, including tumor size, lymph- node involvement, estrogen receptor, and nuclear grade. RESULTS: Only one of the 15 benign breast tumors was shown to be aneusomic for chromosome 1. The other 14 cases of the benign breast tumors showed no evidence of aneusomy for any of the 3 chromosomes. In breast cancers, however, 26 of the 29 cases (90%) were exhibited aneusomy of at least 1 of the 3 chromosomes evaluated and chromosome 1 was most frequently aneusomic (26 of 29 cases (90%)). The present study also suggested a possible correlation between the numeric abnormality of chromosome 1 and estrogen receptor levels. No significant correlations with tumor size, regional lymph-node metastasis, and nuclear grade were observed. CONCLUSION: These findings suggest that chromosome-specific aneusomy is more frequently observed in breast cancers than in benign breast tumors and that aneusomy of chromosome 1 correlates with estrogen receptor levels.

Mapping of Multiple Genetic Alteration Sites of Cervical Carcinomas by Comparative Genomic Hybridization / 대한부인종양콜포스코피학회잡지

Comparative Genomic Hybridization (CGH) is a recently developed molecular cytogenetic technique, which makes it possible to detect chromosomal alteration in solid tumors. To determine whether chromosome alterations are related to cervical carcinoma, we have analyzed 33 cases (24 squamous cell carcinomas and 9 adenocarcinomas, stage Ib-IIIb) from tumor tissues and paraffin embedded tissues by CGH. The cut off value of CGH profiles was 1.15 and 0.85 (green/red ratio). Chromosomal aberrations were detected in 30 out of 33 cases (90.9%). In 32 cases, chromosome 3q was most frequently affected and had greater copy numbers in 20 of tbe 33 cases (60.6%). Interestingly, out of those 20 cases, 10 cases were shown to have a high-level of amplification of chr 3q. In addition to chr 3q, chromosomal gains were observed in chr 1q, 1p, 5p, Sq, 12p, 15q, 19q, 20q, Xp, and Xq. Furthermore chromosomal loss was detected, most commonly in chromosome 11q (11/33). Although less frequent, common losses were also detected in chr 2q, 4p, 4q, Sq, 1 1p, 17p, and 18p. In addition, there were cases of gross chromosome loss for chr 4, 6, 10, 11, 13, 14, 16, 17, 18, 19, 20, 21, 22 and X. In cases involving whole arm deletion, we utilized fluorescence in situ hybridization (FISH) using specific probes a-satellite. We performed HPV typing for 16 and 18 usiag polymerase chain reaction (PCR) and Southem blot analyses. Out of 33 tumor samples, 24 cases (72,7%) were HPV 16 positive, while only 6 cases were positive for HPV 18. two cases were positive for both HPV 16 and 18. We believe that a gain of chromosome 3q as a reeurrent chromosomal aberration may contribute to the tumorigenesis of cervical cancer. However, we could not correlate a pattern of chromosomal aberration with tumor stage or histologic type in cervical cancer.

Prevalence of Balanced Chromosomal Translocations in Couples with Abnormal Reproductive Outcomes and Prenatal Cytogenetic Diagnosis in the Carriers / 대한불임학회지

Cytogenetic analysis was performed in 1321 couples and 141 women with history of abnormal reproductive outcome during 1988-1996. The use of high resolution banding technique and fluorescence in situ hybridization (FISH) in the chromosome analysis has made the precise evaluation of chromosome aberrations. The prevalence of balanced chromosomal translocation carriers were 3.74% (104/2783 patients). 70 cases (2.52%) were reciprocal translocation carriers and 34 (1.22%) had Robertsonian translocations. Chromosome aberrations were more frequent in women (73 cases) than in men (31 cases). No phenotypical abnormalities were found in all carriers, but they experienced abnormal reproductive outcomes such as recurrent spontaneous abortions, anomalous offsprings or infertility problem. Prenatal diagnosis was carried out on 36 subsequent pregnancies in balanced translocation carriers. The fetal karyotypes showed that 12 cases (33%) were normal, 22 (61%) were balanced translocations, and two (6%) were unbalanced translocations. It is concluded that the prevalence of balanced chromosomal translocations in patients with abnormal reproductive outcome is higher than that of the normal population. Most of the fetal samples showed normal karyotypes or balanced translocations. Although the incidence of chromosomal imbalance in the fetuses was relatively low in prenatal diagnosis, individuals with balanced translocations are predisposed to abnormal offspring with partial trisomy or monosomy. Therefore we recommend that genetic counselling and cytogenetic prenatal diagnosis for translocation carriers have to be offered to prevent recurrent chromosomal abnormal babies.