Predictive role of absolute lymphocyte count in daratumumab-treated patients with relapsed/ refractory multiple myeloma

Background/Aims@#Daratumumab has shown an encouraging antitumor effect in patients with multiple myeloma (MM), and was known to alter the immune properties by off-targeting immunosuppressive cells. Here, we aimed to evaluate the change in absolute lymphocyte count (ALC) as a surrogate marker for predicting survival outcomes of patients treated with daratumumab. @*Methods@#Between 2018 and 2021, the medical records of patients with relapsed/refractory MM (RRMM) treated with daratumumab monotherapy at 10 centers in South Korea were reviewed. We collected the ALC data at pre-infusion (D0), day 2 after the first infusion (D2), and prior to the third cycle of daratumumab therapy (D56). @*Results@#Fifty patients who were administered at least two cycles of daratumumab were included. Overall response rate was 54.0% after two cycles of daratumumab treatment. On D2, almost all patients experienced a marked reduction in ALC. However, an increase in ALC on D56 (ALCD56) was observed in patients with non-progressive disease, whereas failure of ALC recovery was noted in those with progressive disease. Patients with ALCD56 > 700/μL (n = 39, 78.0%) had prolonged progression- free survival (PFS) and overall survival (OS) than those with ALCD56 ≤ 700/μL (median PFS: 5.8 months vs. 2.6 months, p = 0.025; median OS: 24.1 months vs. 6.1 months, p = 0.004). In addition, ALCD56 >700/μL was a significant favorable prognostic factor for PFS (hazard ratio [HR], 0.22; p = 0.003) and OS (HR, 0.23; p = 0.012). @*Conclusions@#Increase in ALC during daratumumab treatment was significantly associated with prolonged survival outcomes in patients with RRMM. The ALC value can predict clinical outcomes in patients treated with daratumumab.

Attachment distribution of pectoral muscle origins identified in dual-plane breast implant insertion

Background@#Implant-based dual-plane augmentation mammoplasty requires accurate separation of the pectoralis major muscle (PMM) at its origins. The authors identified the PMM origins during breast reconstruction surgery with the goal of providing additional information on subpectoral implant insertion for reconstructive or aesthetic purposes. @*Methods@#This study was conducted on 67 patients who underwent breast reconstruction surgery at the breast center of our hospital between November 2016 and June 2018. In total, 34 left and 39 right hemithoraces were examined. The left and right hemithoraces were each divided into 15 zones to determine the percentage of PMM attachments in each zone. The distribution of PMM origins in each zone was examined to identify any statistically significant differences. @*Results@#There were no statistically significant differences in the origins of the PMM between the right and left hemithoraces. The percentage of attachments increased moving from the fourth to the sixth rib and from the lateral to the medial aspect. @*Conclusions@#The anatomical findings of this study could be used as a reference for accurate dissection of the origins of the PMM for the preparation of the subpectoral pocket for subpectoral implant placement.

Favorable long-term survival using consolidation chemotherapy without allogeneic hematopoietic cell transplantation for acute myeloid leukemia with wild-type NPM1 without FLT3-ITD

BACKGROUND: The role of allogeneic hematopoietic cell transplantation (allo-HCT) compared with consolidation chemotherapy alone in intermediate-risk acute myeloid leukemia (AML) patients with wild-type nucleophosmin/negative or a low level of Fms related tyrosine kinase 3 internal tandem duplication (NPM1(wt)/FLT3-ITD(neg/low)) has not yet been elucidated. METHODS: In this study, we retrospectively investigated 88 patients newly diagnosed with AML who received intensive induction chemotherapy at Kyungpook National University Hospital from March 2015 to July 2017. The selection criteria included the presence of results on genetic abnormalities including NPM1 and FLT3-ITD. RESULTS: According to the European LeukemiaNet (ELN) risk classification, 25 patients (28%) were categorized as favorable, 44 (50%) as intermediate, and 19 (22%) as adverse risk. Among the intermediate-risk patients, 40 were identified as NPM1 wt/FLT3-ITDneg/low. Among the patients with NPM1(wt)/FLT3-ITD(neg/low), complete remission (CR) was achieved in 26 patients out of 40 (65%). One-year overall survival (OS) rate was 100% in the favorable-risk group and 87.9% in the NPM1(wt)/FLT3-ITD(neg/low) group (P=0.233). Among the intermediate-risk NPM1(wt)/FLT3-ITD(neg/low) patients, there was no survival benefit with allo-HCT (N=19) compared to consolidation chemotherapy (N=21; P=0.372). In the multivariate analysis, the ELN risk group [hazard ratio (HR), 6.36; P=0.019] and the achievement of CR (HR, 2.95; P=0.017) were both identified as factors affecting OS of patients with newly diagnosed AML. CONCLUSION: Among the AML patients, intermediate-risk NPM1(wt)/FLT3-ITD(neg/low) patients and favorable-risk patients showed similar OS rates. Our results suggested that allo-HCT might have limited clinical benefit for the intermediate-risk NPM1(wt)/FLT3-ITD(neg/low) patients. Well controlled studies are needed to confirm the current results.

A Case of Pneumocystis jirovecii Pneumonia Following CMV Duodenitis in a Kidney Transplant Patient / 대한신장학회지

Solid organ transplant recipients are at increased risk for various opportunistic infections because of their immunocompromised state. Pneumocystis jirovecii (carinii) infection has posed serious problems in these patients which can be life threatening. It has been reported that incidences of Pneumocystis infection have dramatically decreased with the use of prophylactic antibiotics. However, there have been reports that say the risks of Pneumocystis infection are increasing with the use of new immunosuppressive drugs and in presence of preceding immunomodulating infections such as CMV infection which is another common opportunistic infection in transplant patients. There were only a few case reports abroad on Pneumocystis infection following CMV infection in patients who underwent kidney transplantation. In Korea, however, there hasnt been any report of such cases. Herein we report a case of a kidney transplant patient who experienced a serious episode of Pneumocystis jirovecii pneumonia following CMV duodenitis. After adequate mechanical ventilation and use of antibiotics the patient completely recovered without any complications.

Analysis of Factors Related to Health Behavior of the ROKAF Pilots

BACKGROUND: ROKAF (Republic of Korea Air Force) Pilots are required to maintain optimal health status because of their job characteristics and importance as core forces. Their optimal health status can be achived by prac-ticing good health behavior. Therefore, this study tries to analyze the pilots' health behaviors for last 1 month and latest 12 hours before flight respectively, and to examine factors related to health behavior. The goal is to provide data for the development of more efficient nursing interventions. METHODS: In this study, 200 Air Force pilots was interviewed from Oct. 1 to Oct. 15, 2001. by the use of a structured questionnaire. Collected data was analyzed using SPSS Windows Version 10.0 for descriptive statistics, x2-test, Spearman's rho correlation. RESULTS: ROKAF Pilot's have good drinking and smoking habits and their alcohol drinking, smoking, dietary habits, sleeping hours is related to their Self-efficacy, perceived barrier, family support. Also, their before flight health behavior was not different largely their casual health behavior. CONCLUSION: In order to promote ROKAF Pilot's health status, programs should be designed according to age, aircraft types and marriage conditions, and strategies that enable to increase health behavior self-efficacy and to decrease perceived barrier should be employed.

A the Study on Relationship Among Diphosphoglycerate (2.3-DPG), Arteriovenous Oxygen Content Difference (A-VO2) and Tissue O2 Delivery of the Patients with Chronic Lung Disease (CLD) / 대한내과학회지

OBJECTIVES: The presence of chronic low oxygen delivery to the tissues (blood flow X Hb concentration X arterovenous oxygen content difference) in patients with chronic lung disease (CLD) leads to a aggravated dyspnea. Therefore, total oxygen delivery to the tissues is a reverse correlation with severity of dyspnea. So far, the treatment of patients with CLD has been limited to only the increase of ventilation and perfusion capacity. However, this study focused on the capacity of oxygen delivery to the tissues in patients with CLD. We measured blood oxygen parameters as one of the extended approaches. METHOD: Simultaneous arterial and venous blood samples from 15 patients with CLD at rest were evaluated for 2.3-DPG, CO-Hb (Carboxy-monohe-moglobin), Met-Hb (methomoglobin), ABGA (Arterial blood gas analysis), VBGA (Venous blood gas analysis) and Hb (Hemoglobin). Smokers and patients with other disease were excluded from the study in order to avoid the factors (2.3-DPG, CO-Hb etc.) which can shift the oxygen dissociation curve. There were 12 men and 3 women, ranging in age from 40 to 75 years. The disease onset varied from 3 years to more than 30 years. RESULTS: 1) As total oxygen delivery to the tissues decreased, Ao2(Arterial oxygen partial pressure) and A-VCb (Arteriovenous oxygen content difference) decreased, while 2.3-DPG increased. Total oxygen delivary to the tissues showed a significant correlation with more A-V and 2.3-DPG than AO2. 2) AO2 had a correlation with A-VO2 but AO2 did not clearly reflect A-VO2. 3) 2.3-DPG activity depended on more A-VO2 than AO2. 4) As A-VO2 decreased, there was more significant relationship among 2.3-DPG, A-VO2 and tissue oxygen delivery. 5) A-VO2 showed a significant reverse correlation with 2.3-DPG as well as Met-Hb % + CO-Hb %. 6) ACO2 (arterial carbon dioxide partial pressure) showed a correlation with 2.3-DPG as well as A-VO2. 7) Arterial PH did not correlate with 2.3-DPG as well as A-V. CONCLUSION: 1) AO2 in patient with CLD correlated with A-VO2 but AO2 did not clearly reflect A-V. 2) Total oxygen delivery (severity of dyspnea) showed a significant correlation with more A-VO2 and 2.3-DPG than AO2. 3) 2.3-DPG activity depended on more A-VO2 than AO2. 4) 2.3-DPG activity had a reverse correlation with A-V in spite that 2.3-DPG shifts the oxygen dissociation curve to the right, because 2.3-DPG shift is secondary change associated with the low oxygen delivery to the tissues, More extensive k prospective investigations are needed to clearly define correlation among A-VO2, 2.3-DPG and prognosis of patients with CLD.

A study on the immune reaction to the milk protein antigens in the postpartum mother, newborn baby, and children

No abstract available.

Osteogenic Sarcoma as Second Malignant Neoplasm After Treatment of Retinoblastoma

No abstract available.

The Evaluation of Left and Right Ventricular Function by Radionuclide Ventriculography and Echocardiography in Dilated Cardiomyopathy

It has been known that dilated cardiomyopathy(DCM) is characterized by systolic dysfunction of left ventricle(LV), but there were few studies about correlation between LV systolic function, diameter and diastolic function measured by echocardiography and radionuclide ventriculography(RVG) The purpose of this study is to evaluate LV systolic and diastolic function as well as RV function using regional ejection fraction and functional images by RVG in 17 patients with DCM and to compare these variables with echocardiographic data. The results are as follows : 1) DCM showed diffuse systolic and diastolic dysfunction of LV. The systolic impairment is accounted for the diastolic impairment in DCM. 2) The increased standard deviation of phase angle of left ventricle(LVSDph) revealed LV asynchronous contraction in DCM. 3) LVSDph showed significant correlations with other RVG parameters such as LV ejection fraction, and peak ejection rate, peak filling rate and also with LV systolic and diastolic diameter measured by echocardiography. It is concluded that LVSDph may be useful in evaluation of LV systolic and diastolic function in patients with DCM as well as LV asynchronous contraction.

Two Cases of Hand-Schuller-Christian Disease in Monozygotic Twin

No abstract available.