The 2016 WHO versus 2008 WHO Criteria for the Diagnosis of Chronic Myelomonocytic Leukemia

The 2016 WHO diagnostic criteria for chronic myelomonocytic leukemia (CMML) require both absolute and relative monocytosis (≥1×10⁹/L and ≥10% of white blood cell counts) in peripheral blood. Moreover, myeloproliferative neoplasm (MPN) features in bone marrow and/or MPN-associated mutations tend to support MPN with monocytosis rather than CMML. We assessed the impact of the 2016 WHO criteria on CMML diagnosis, compared with the 2008 WHO criteria, through a retrospective review of the medical records of 38 CMML patients diagnosed according to the 2008 WHO classification. Application of the 2016 WHO criteria resulted in the exclusion of three (8%) patients who did not fulfill the relative monocytosis criterion and eight (21%) patients with an MPN-associated mutation. These 11 patients formed the 2016 WHO others group; the remaining 27 formed the 2016 WHO CMML group. The significant difference in the platelet count and monocyte percentage between the two groups indicated that the 2016 WHO criteria lead to a more homogenous and improved definition of CMML compared with the 2008 WHO criteria, which may have led to over-diagnosis of CMML. More widespread use of molecular tests and more sophisticated clinical and morphological evaluations are necessary to diagnose CMML accurately.

A Prospective Study on Nutritional Status and Nutrient Intake of Hemodialysis Patients Based on Coexistence of Diabetes

It is well known that malnutrition is a predictor of mortality in hemodialysis patients. The number of diabetic nephropathy patients is increasing rapidly. This study aimed to investigate nutritional status and nutrient intake according to the presence of diabetes among hemodialysis patients. The nutritional intake and general characteristics of outpatients at Ajou University Hospital (24 with diabetes and 30 without diabetes) were investigated between July and September 2015. Patients' general data were collected, and nutritional status by Patient-Generated Subjective Global Assessment (PG-SGA) was evaluated. Nutrient intakes were assessed according to 3-day food records. There was no significant difference regarding body weight between the two groups. However, the non-diabetic group showed a better nutritional status by Patient-Generated Subjective Global Assessment (PG-SGA) (5.2±4.4 vs. 8.0±4.3 score, non-diabetics vs. diabetics, P<0.05). There was no difference in daily calorie intake (1,473.9±370.5 vs. 1,503.8±397.5 kcal) and protein intake (60.3±19.7 vs. 65.6±20.5 g) in those with diabetes. Intakes of vegetables protein, sodium, potassium, vitamin C, folic acid and fiber were significantly higher in the diabetic group compared to those of the non-diabetic group. There was no difference in daily nutrient intake between the hemodialysis weekday and weekend groups. The non-diabetic group had higher calorie and sodium intakes per meal in the hemodialysis weekday group, but the difference was not significant. Based on these results, intervention should be performed to improve nutritional status in consideration of diabetes and dietary patterns.

A Case of Therapy-Related Acute Leukemia With Mixed Phenotype With BCR-ABL1 After Treatment of Diffuse Large B-Cell Lymphoma

No abstract available.

Effects of Peer Helper Training Program on Existential Spiritual Well-being, Peer Relationship, and Depression for Students Attending a Specialized Girls Vocational High School / 정신간호학회지

PURPOSE: The aim of this study was to investigate the effects of a peer helper training program on existential spiritual well-being, peer relationship, and depression for students attending a specialized girls vocational high school. METHODS: The participants were forty-two students attending a specialized girls vocational high school in D city. Data were collected form october 23 to December 24, 2013. To test the effects of the peer helper training program, the participants were divided into two mached groups, an experimental group (21) and a control group (21). Data were analyzed using chi2-test, Fisher exact probability test, and t-test with the SPSS/WIN 12.0 program. RESULTS: After attending the peer helper training program, significant differences between the experimental group and the control group were found for existential spiritual well-being (t=3.35, p=.002) and peer relationship (t=2.29, p=.028). However, there was no significant differences in depression between the two groups. CONCLUSION: The results indicate that the peer helper training program enhances existential spiritual well-being and peer relationship for students attending a specialized girls vocational high school. Therefore, this program is a good strategy that teachers and community mental health nurses can use to increase existential spiritual well-being and peer relationship of these high school girls.

Case of Donor Cell Leukemia after Allogenic Bone Marrow Transplantation for Severe Aplastic Anemia / 대한내과학회지

Globally, there have been a small number of donor cell leukemia cases reported but, to our knowledge, none have been reported in Korea until now. Donor cell leukemia is a rare though well-recognized complication that occurs after allogenic hematopoietic stem cell transplantation (allo-HSCT). Herein, we report the case of an 18-year-old woman who developed acute lymphoblastic leukemia originating from donor cells after allo-HSCT.

Adequacy of Lipid Emulsion Administration Prescription Rate in a Single Center

PURPOSE: IV-lipid emulsion can be a nutritional supplement to provide essential fatty acids and energy for patients who need total parenteral nutrition support. The recommended administration dose of lipid emulsion is less than 2.5 g/kg/d and the rate should not exceed 0.15 g/kg/h for adult patients. The purpose of this study is to evaluate the adequacy of the currently prescribed administration rate of IV-lipid emulsion in a single center. METHODS: We analyzed 1,739 lipid emulsion administration prescriptions in 1,095 patients over 18 years old at Ajou University Hospital from January 1, 2014 to March 31. RESULTS: The median prescription rate of total lipid emulsion was 0.134 (0.012~1.125) g/kg/h, and the exceeding portion of maximum recommended infusion rate was 36.9%. The median administration prescription rate of lipid emulsion was faster in 500 mL emulsions, compared to 250 mL emulsion (0.146 g/kg/h vs. 0.075 g/kg/h; P<0.001) and at emergency room (ER), compared to general ward (0.154 g/kg/h vs. 0.123; P<0.001). The exceeding portion of maximum recommended infusion rate of lipid emulsion was also higher in 500 mL emulsion, compared to 250 mL emulsion (52.2% vs. 30.4%; P<0.001) and at ER, compared to general ward (52.1% vs. 30.4%; P<0.001). Triglyceride level was higher in exceeding recommended infusion rate compared to less, but not statistically significant (119 mg/dL vs. 261 mg/dL; P=0.202). CONCLUSION: Administration prescription rate of lipid emulsion exceeded the recommended rate and this feature was dominant in 500 mL emulsion and at ER. Education and monitoring of lipid emulsion prescription is needed for appropriate lipid administration and prevention of fat overload syndrome.

Current routine practice and clinico-pathological characteristics associated with acute promyelocytic leukemia in Korea

BACKGROUND: Acute promyelocytic leukemia (APL) can be life threatening, necessitating emergency therapy with prompt diagnosis by morphologic findings, immunophenotyping, cytogenetic analysis, or molecular studies. This study aimed to assess the current routine practices in APL and the clinico-pathologic features of APL. METHODS: We reviewed the medical records of 48 Korean patients (25 men, 23 women; median age, 51 (20-80) years) diagnosed with APL in 5 university hospitals between March 2007 and February 2012. RESULTS: The WBC count at diagnosis and platelet count varied from 0.4 to 81.0 (median 2.0)x10(9)/L and 2.7 to 124.0 (median 54.5)x10(9)/L, respectively. The median values for prothrombin time and activated partial thromboplastin time were 14.7 (11.3-44.1) s and 29 (24-62) s, respectively. All but 2 patients (96%) showed a fibrin/fibrinogen degradation product value of >20 microg/mL. The D-dimer median value was 5,000 (686-55,630) ng/mL. The t(15;17)(q22;q12 and PML-RARA fusion was found in all patients by chromosome analysis and/or multiplex reverse transcriptase-polymerase chain reaction (RT-PCR), with turnaround times of 8 (2-19) d and 7 (2-13) d, respectively. All patients received induction chemotherapy: all-trans retinoic acid (ATRA) alone (N=11, 26%), ATRA+idarubicin (N=25, 58%), ATRA+cytarabine (N=3, 7%), ATRA+idarubicin+cytarabine (N=4, 9%). CONCLUSION: Since APL is a medical emergency and an accurate diagnosis is a prerequisite for prompt treatment, laboratory support to implement faster diagnostic tools to confirm the presence of PML-RARA is required.

Current routine practice and clinico-pathological characteristics associated with acute promyelocytic leukemia in Korea

BACKGROUND: Acute promyelocytic leukemia (APL) can be life threatening, necessitating emergency therapy with prompt diagnosis by morphologic findings, immunophenotyping, cytogenetic analysis, or molecular studies. This study aimed to assess the current routine practices in APL and the clinico-pathologic features of APL. METHODS: We reviewed the medical records of 48 Korean patients (25 men, 23 women; median age, 51 (20-80) years) diagnosed with APL in 5 university hospitals between March 2007 and February 2012. RESULTS: The WBC count at diagnosis and platelet count varied from 0.4 to 81.0 (median 2.0)x10(9)/L and 2.7 to 124.0 (median 54.5)x10(9)/L, respectively. The median values for prothrombin time and activated partial thromboplastin time were 14.7 (11.3-44.1) s and 29 (24-62) s, respectively. All but 2 patients (96%) showed a fibrin/fibrinogen degradation product value of >20 microg/mL. The D-dimer median value was 5,000 (686-55,630) ng/mL. The t(15;17)(q22;q12 and PML-RARA fusion was found in all patients by chromosome analysis and/or multiplex reverse transcriptase-polymerase chain reaction (RT-PCR), with turnaround times of 8 (2-19) d and 7 (2-13) d, respectively. All patients received induction chemotherapy: all-trans retinoic acid (ATRA) alone (N=11, 26%), ATRA+idarubicin (N=25, 58%), ATRA+cytarabine (N=3, 7%), ATRA+idarubicin+cytarabine (N=4, 9%). CONCLUSION: Since APL is a medical emergency and an accurate diagnosis is a prerequisite for prompt treatment, laboratory support to implement faster diagnostic tools to confirm the presence of PML-RARA is required.

A Retrospective Study of Bone Mineral Density in Patients with Endometrial Cancer without Bone Metastases / 대한골다공증학회지

OBJECTIVES: This retrospective study evaluated bone mineral density (BMD) in postmenopausal endometrial cancer patients without bone metastases. MATERIALS AND METHODS: We retrospectively analyzed the BMD of spinal bone and the femur in 26 endometrial cancer patients and 32 control women. All of the patients and control women had reached their menopause. The control group was treated with benign uterine myoma whose age and body mass index are consistent with the case group. All BMD was measured by dual-energy X-ray absorptiometry.

Interpersonal Relationships and Suicide Probability among Korean Adolescents / 정신간호학회지

PURPOSE: This study was done to identify predictive factors influencing suicide probability in Korean adolescents. METHODS: Participants in the study were 575 adolescents from 17 schools with quota sampling by each region in D city. The data were collected from October to November, 2010 using self-report questionnaires about interpersonal relationships and suicide probability (SPS) and analyzed using descriptive statistics, one-way ANOVA with Scheffe of Post Hoc, Pearson's correlation coefficients, and stepwise multiple regression analysis with SPSS/WIN 16.0 program. RESULTS: Suicide probability showed a significantly negative correlation for interpersonal relations with parents, friends and teachers. Interpersonal relationship with parents (p<.001) explained 32% of suicide probability, compared to relationships with peers or teachers, which together was accounted for 46% of the variance. CONCLUSION: The findings suggest that interpersonal relationships with parents should be considered when adolescents suffer from suicidal thinking. Various effective strategies to improve relationships with parents are important to reduce suicide in adolescents.

Successful Chemotherapy Following Autologous Stem Cell Transplantation in Multiple Myeloma and Multi-organ Dysfunction with Infiltration of Eosinophils: A Case Report / Journal of the Korean Cancer Association, 대한암학회지

Eosinophils are derived from hematopoietic stem cells. Peripheral blood eosinophilia is defined as an absolute eosinophil count of > or =0.5x10(9)/L. Eosinophilia is classified into primary or clonal eosinophilia, secondary eosinophilia, and idiopathic categories including idiopathic hypereosinophilic syndrome. Both hematopoietic and solid neoplasms may be associated with peripheral blood eosinophilia, but multiple myeloma is rarely associated with eosinophilia. We now report the case of a 31-year-old man with multiple myeloma associated with marked eosinophilia who developed multiple organ dysfunction with infiltration of eosinophils. He recovered after treatment with chemotherapy followed by autologous stem cell transplantation.

Successful Chemotherapy Following Autologous Stem Cell Transplantation in Multiple Myeloma and Multi-organ Dysfunction with Infiltration of Eosinophils: A Case Report / Journal of the Korean Cancer Association, 대한암학회지

Eosinophils are derived from hematopoietic stem cells. Peripheral blood eosinophilia is defined as an absolute eosinophil count of > or =0.5x10(9)/L. Eosinophilia is classified into primary or clonal eosinophilia, secondary eosinophilia, and idiopathic categories including idiopathic hypereosinophilic syndrome. Both hematopoietic and solid neoplasms may be associated with peripheral blood eosinophilia, but multiple myeloma is rarely associated with eosinophilia. We now report the case of a 31-year-old man with multiple myeloma associated with marked eosinophilia who developed multiple organ dysfunction with infiltration of eosinophils. He recovered after treatment with chemotherapy followed by autologous stem cell transplantation.

A case of nasal-type NK/T cell lymphoma with cutaneous and ocular involvement / 대한내과학회지

Natural killer (NK)/T cell lymphoma is a lethal midline granuloma that produces necrotic and granulomatous lesions in the upper respiratory tract, especially in the nasal cavity. This tumor affects the nose and midface, but can also arise in the skin, gastrointestinal tract, testes, central nervous system, lungs, salivary glands, bone marrow, and larynx. Five to eight percent of extranodal lymphomas involve the orbit, and 1.3~2.0% of these present as primary orbital tumors. The skin can also be the primary site of NK/T cell lymphomas. Aside from affecting the nasal and facial skin, the tumor can involve the skin of the postauricular area, back, trunk, and upper and lower extremities. We present the case of a 37-year-old woman who had a nasal NK/T cell lymphoma with cutaneous and ocular involvement.

Long-Term Exercise Training Attenuates Age-Related Diastolic Dysfunction: Association of Myocardial Collagen Cross-Linking

The incidence of diastolic heart failure increases dramatically with age. We investigated the impact of long-term exercise training on age-related diastolic dysfunction. Old (25-month-old) male Fischer 344 rats were studied after 12 weeks of treadmill exercise training or sedentary cage life (N=7, in each group). We determined cardiac performance using a pressure-volume conductance catheter and magnetic resonance imaging. Collagen volume fraction (CVF) and myocardial collagen solubility by pepsin as an index of advanced glycation end products (AGEs) crosslinked collagen were measured. The maximal slope of systolic pressure increment (+dP/dt) and the slope of end-systolic pressure-volume relation were higher, and end diastolic volume (EDV), delta EDV (the percentage of the EDV increment-to-baseline EDV) and the slope of end-diastolic pressure-volume relation were lower in training group. The maximal slope of diastolic pressure decrement (-dP/dt) and time constant of LV pressure decay (tau) had no difference. AGEs cross-linked collagen, not CVF was reduced by exercise training. Long-term exercise training appears to attenuate age-related deterioration in cardiac systolic function and myocardial stiffness and could be reduce in pathologic AGEs cross-linked collagen in myocardium.

Practical Application of Quantitative HiSens Auto Rapid Plasma Reagin Latex Turbidimetric Immunoagglutination for Diagnosing Syphilis; Comparison Analysis between Rapid Plasma Reagin Latex Turbidimetric Immunoagglutination Test and Rapid Plasma Reagin Car / 감염과화학요법

BACKGROUND: The purpose of this study was to evaluate validity of quantitative RPR LTIA, HiSens Auto RPR LTIA (HBi Corp., South Korea) and to decide an adequate cutoff value for syphilis screening. MATERIALS AND METHODS: A total of 549 serums or plasma specimens from patients were tested with RPR LTIA and RPR card tests. Degree of agreement between the two methods was analyzed, and validity of RPR LTIA test was analyzed by receiver operating characteristic (ROC) curves. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and ROC statistics of the RPR LTIA test were analyzed to decide an adequate cutoff value. RESULTS: Agreement analysis showed slight to moderate agreement (k=0.093-0.588, P=0.000). Kappa value had its highest value at the cutoff value of 1.3 and 1.6 (k=0.588, P=0.000). Kappa value at the cutoff value of 1 ranked second (k=0.578. P=0.000). A plot of ROC curve showed a statistically valid result to differentiate between a syphilis test positive group and a syphilis test negative group (AUC=0.92, P=0.000). The cutoff values in RPR LTIA test ranged between 0.65 and 1.15 when both sensitivity and specificity were higher than 80%. CONCLUSION: HiSens Auto RPR LTIA test showed statistically valid result to differentiate between syphilis test groups. Considering the importance of sensitivity in screening for syphilis and the degree of agreement with RPR card test, the cutoff value of 1 in HiSens Auto RPR LTIA test is thought to be adequate.

Practical Application of Quantitative HiSens Auto Rapid Plasma Reagin Latex Turbidimetric Immunoagglutination for Diagnosing Syphilis; Comparison Analysis between Rapid Plasma Reagin Latex Turbidimetric Immunoagglutination Test and Rapid Plasma Reagin Car / 감염과화학요법

BACKGROUND: The purpose of this study was to evaluate validity of quantitative RPR LTIA, HiSens Auto RPR LTIA (HBi Corp., South Korea) and to decide an adequate cutoff value for syphilis screening. MATERIALS AND METHODS: A total of 549 serums or plasma specimens from patients were tested with RPR LTIA and RPR card tests. Degree of agreement between the two methods was analyzed, and validity of RPR LTIA test was analyzed by receiver operating characteristic (ROC) curves. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and ROC statistics of the RPR LTIA test were analyzed to decide an adequate cutoff value. RESULTS: Agreement analysis showed slight to moderate agreement (k=0.093-0.588, P=0.000). Kappa value had its highest value at the cutoff value of 1.3 and 1.6 (k=0.588, P=0.000). Kappa value at the cutoff value of 1 ranked second (k=0.578. P=0.000). A plot of ROC curve showed a statistically valid result to differentiate between a syphilis test positive group and a syphilis test negative group (AUC=0.92, P=0.000). The cutoff values in RPR LTIA test ranged between 0.65 and 1.15 when both sensitivity and specificity were higher than 80%. CONCLUSION: HiSens Auto RPR LTIA test showed statistically valid result to differentiate between syphilis test groups. Considering the importance of sensitivity in screening for syphilis and the degree of agreement with RPR card test, the cutoff value of 1 in HiSens Auto RPR LTIA test is thought to be adequate.

Effect of Nursing Intervention on the Knowledge, Health Beliefs, Self Efficacy and Rescreening Compliance of Cervical Cancer Screening Clients / 여성건강간호학회지

PURPOSE: This study was done to determine the effect of nursing interventions on the knowledge of cervical cancer, and health beliefs, self efficacy and rate of rescreening compliance. METHOD: This was a nonequivalent control group pretest-posttest design. The subjects were 93 women who had experienced cervical cancer screening in S city and were randomly assigned to the experimental or control group. Intervention tools were a screening record pocket book, phone-coach. and watching a video(17mins). The data was collected from April to December, 2003 and analyzed using an chi-square-test. t-test and ANCOVA. RESULTS: The 1st hypothesis, "The Posttest knowledge score of the experimental group will be significantly higher than that of the control group" was supported (F=11.16, p= .001). The 2nd hypothesis, "The Posttest health belief score of the experimental group will be significantly higher than that of the control group" was not supported(F=3.38, p= .069). The 3rd hypothesis, "The Posttest self efficacy score of the experimental group will be significantly higher than that of the control group" was supported(F=4.36, p= .040). The 4th hypothesis, "The Rescreening compliance rate of the experimental group after the nursing intervention will be significantly higher than that of the control group" was supported(chi-square=3.45, p= .050). CONCLUSION: This nursing intervention was effective in increasing the knowledge of cervical cancer, and self efficacy percentage of rescreening compliance. Therefore I think this intervention can be used for promoting the rescreening compliance of women.

Clinical Significance of Reticulocyte Maturation Parameters in the Differential Diagnosis of Macrocytic Anemias / 대한진단검사의학회지

BACKGROUND: Macrocytic anemias are commonly seen in clinical practice, and precise etiologic diagnosis is essential for proper management. We evaluated the clinical utility of reticulocyte maturation parameters in macrocytic anemias to discriminate among myelodysplastic syndrome (MDS), megaloblastic anemia (MA), and non-megaloblastic macrocytic anemia associated with chronic liver disease (MA-CLD). METHODS: Using an automated reticulocyte counter, we retrospectively analyzed and compared reticulocyte maturation parameters including immature reticulocyte fraction (IRF), mean reticulocyte volume (MRV), mean sphered cell volume (MSCV) of normal control (N=34), and patients diagnosed with MDS (N=31), MA (N=52), and MA-CLD (N=196). RESULTS: Macrocytic anemias from MA, MDS and MA-CLD showed higher values of reticulocyte maturation parameters including IRF, MRV and MSCV than normal control (P or = 0.39), MRV (> or = 129.5 fL), and MSCV (> or = 102.3 fL) makes the diagnosis of MA-CLD unlikely and underlying MDS should be considered.

The Effects on Antimicrobial and Cytotoxicity of Hijikia Fusiformis Fraction

In this study, we investigated antimicrobial and cytotoxicity effects to each fraction extracted from Hizikia fusiformis (HF), which were extracted methanol (HFM)and then the extract was fractionated into four different types: hexane (HFMH), methanol (HFMM), butanol (HFMB) and aquous (HFMA) partition layers. We determined the cytotoxic effect of these layers on human cancer cells by MTT assay. Among various partition layers of HF, the HFMB and HFMM were showed the strong cytotoxic effects on cancer cell lines we used. The quinone reductase (QR) induced activity of the HFMB on HepG2 cells at 150 microgram/mL concentration was 2.63 times more effective compared to the control value of 1.0. Although further studies are needed, the present work suggests that HF maybe a chemopreventive agent for the treatment of human cancer cells.

A case of Niemann-Pick disease type A / 소아과

Niemann-Pick disease is a group of autosomal recessive disorders associated with hepatosplenomegaly, variable neurologic deficits, and the storage of sphingomyelin and other lipids. Seven cases have been reported in Korea. We report an additional case presenting with hypotonia, early neurodevelopmental delay, hepatosplenomegaly and death by persistent pneumonia and asphyxia at the age of 23 months. MRI of brain and fundoscopic findings of our case at 4 months of age were normal. However, abnormal intensity of the thalamus and atrophy of the right temporal lobe on the MRI and macular cherry red spots were noticed at the age of 17 months. A bone marrow biopsy showed large foamy cells, while hexosaminidase A and B levels were normal. Although biochemical or molecular workup was not done, these findings led to the diagnosis of infantile onset Niemann-Pick disease, probably type A. A brief review of the related literatures was made.