Evaluation of static fracture resistances and patterns of pulpless tooth restored with poly-ether-ketone-ketone (PEKK) post / 대한치과보철학회지

PURPOSE: The purpose of present study was to investigate fracture strength and mode of failure of endodontically treated teeth restored with metal cast post-core system, prefabricated fiber post system, and newly introduced polyetherketoneketone (PEKK) post-core system. MATERIALS AND METHODS: A total of 21 mandibular premolar were randomly grouped into 3 groups of 7 each according to the post material. Group A was for metal cast post core; Group B for prefabricated glass fiber post and resin core; and Group C for milled PEKK post cores. All specimens were restored with metal crown. The fracture strength of each specimen was measured by applying a static load of 135-degree to the tooth at 2 mm/min crosshead speed using a universal testing machine. After the fracture strength measurement, the mode of failure was observed. The results were analyzed using Kruscal-Wallis test and post hoc Mann-Whitney U test at confidence interval α = .05. RESULTS: Fracture resistance of PEKK post core was lower than those of cast metal post and fiber reinforced post with composite resin core. In the aspect of fracture mode most of the root fracture occurred in the metal post core, whereas the post detachment occurred mainly in the fiber reinforced post. In the case of PEKK post core, teeth and post were fractured together. CONCLUSION: It is necessary to select appropriate materials of post for extensively damaged teeth restoration and clinical application of the PEKK post seems to require more research on improvement of strength.

Accuracy of new implant impression technique using dual arch tray and bite impression coping

PURPOSE: The purpose of this in vitro study was to evaluate the accuracy of a new implant impression technique using bite impression coping and a dual arch tray. MATERIALS AND METHODS: Two implant fixtures were placed on maxillary left second premolar and first molar area in dentoform model. The model with two fixtures was used as the reference. The impression was divided into 2 groups, n=10 each. In group 1, heavy/light body silicone impression was made with pick up impression copings and open tray. In group 2, putty/light body silicone impression was made with bite impression copings and dual arch tray. The reference model and the master casts with implant scan bodies were scanned by a laboratory scanner. Surface tessellation language (STL) datasets from test groups was superimposed with STL dataset of reference model using inspection software. The three-dimensional deviation between the reference model and impression models was calculated and illustrated as a color-map. Data was analyzed by independent samples T-test of variance at α=.05. RESULTS: The mean 3D implant deviations of pick up impression group (group 1) and dual arch impression group (group 2) were 0.029 mm and 0.034 mm, respectively. The difference in 3D deviations between groups 1 and 2 was not statistically significant (P=.075). CONCLUSION: Within limitations of this study, the accuracy of implant impression using a bite impression coping and dual arch tray is comparable to that of conventional pick-up impression.

Evaluation of reverse torque value of abutment screws on CAD/CAM custom-made implant abutments / 대한치과보철학회지

PURPOSE: The purpose of this study was to compare the screw joint stability between the CADCAM custom-made implant abutment and the prefabricated implant abutment by measuring the reverse torque value after cyclic loading. MATERIALS AND METHODS: Twelve screw type implants (Implantium, Dentium Co., Seoul, Korea) were embedded in aluminum cylinder with acrylic resin. The implant specimens were equally divided into 3 groups, and connected to the prefabricated titanium abutments (Implantium, Dentium Co., Seoul, Korea), CADCAM custom-made titanium abutments (Myplant, Raphabio Co., Seoul, Korea) and CADCAM custom-made zirconia abutments (Zirconia Myplant, Raphabio Co., Seoul, Korea). The CAD-CAM milled titanium crown (Raphabio Co., Seoul, Korea) was cemented on each implant abutment by resin cement. Before cyclic loading, each abutment screw was tightened to 30 Ncm and the reverse torque value was measured about 30 minutes later. After the crown specimen was subjected to the sinusoidal cyclic loading (30 to 120 N, 500,000 cycles, 2 Hz), postloading reverse torque value was measured and the reverse torque loss ratio was calculated. Kruskal-Wallis test was used for statistical analysis of the reverse torque loss ratio. RESULTS: The CADCAM custom-made titanium abutments presented higher values in reverse torque loss ratio without statistically significant differences than the prefabricated titanium abutments (P>.05). Reverse torque loss ratio of the custom-made zirconia abutments was significantly higher compared to that of the prefabricated titanium abutments (P=.014). CONCLUSION: Within the limitation of the present in-vitro study, it was concluded that there was no significant difference in screw joint stability between the CADCAM custom-made titanium abutments and the prefabricated titanium abutments. On the other hand, the CADCAM custom-made zirconia abutments showed lower screw joint stability than prefabricated titanium abutments.

A clinical evaluation of efficacy of an office bleaching gel containing 30% hydrogen peroxide / 대한치과보존학회지

This study evaluated the efficacy of an office bleaching gel (RemeWhite, Remedent Inc., Deurle, Belgium) containing 30% hydrogen peroxide. 31 volunteers were recieved office bleaching with the RemeWhite for 3 times at one visit, total 2 visits. As control group, the same gel in which hydrogen peroxide was not included was applied to 31 volunteers with the same protocol. The shade change (DeltaE*, color difference) of 12 anterior teeth was measured using Colorimerter and Vitapan classical shade guide. The shade change of overall teeth in the experimental group was significantly greater than that in the control group which was measured using Colorimeter. There was also a significant difference between baseline and 14 weeks or 26 weeks though color rebounding phenomenon occurred as time went by. Small shade change difference can be measured accurately using Colorimeter than using Vitapan classical shade guide.

The evaluation of clinical efficacy and longevity of home bleaching without combined application of In-office bleaching / 대한치과보존학회지

OBJECTIVES: The purpose of this study was to evaluate the whitening efficacy and longevity of home bleaching. MATERIALS AND METHODS: A total of 28 patients were divided into either experimental group (Opalescence F; 15% carbamide peroxide) or control group randomly. The patients in experimental group were instructed to wear individual trays applied with bleaching gel for 2 hours a day for 4 weeks. Any treatments weren't applied to the patients in control group. The color measurements of central incisors, lateral incisors & canines of upper and lower arch were recorded at base line, immediately after the finishment of treatmemt (4 weeks), 8 weeks and 12 weeks using Colorimeter (Chroma Meter, 2600d Konica Minolta co.) and Vitapan classical shade guide (Vita Zahnfabrik). RESULTS: A significantly stronger color change was observed for overall teeth samples in experimental group immediately after treatment (at 4 weeks) compared to ones in control group (p < 0.05). There was also a significant difference between baseline and 8 weeks or 12 weeks separately though color rebouncing phenomenon occurred as time went by (p < 0.05). CONCLUSIONS: The clinical effecacy and longevity of home bleaching without combined application of in-office bleaching was observed through this experiment.

A clinical evaluation of safety of an office bleaching gel containing 30% hydrogen peroxide / 대한치과보존학회지

This study evaluated the safety of an office bleaching gel (RemeWhite, Remedent Inc., Deurle, Belgium) containing 30% hydrogen peroxide. 37 volunteers were recieved office bleaching with the RemeWhite for 3 times at one visit, total 2 visits. As control group, the same gel in which hydrogen peroxide was not included was applied to 34 volunteers with the same protocol. There was no difference between experimental group and control group using electric pulp test. In the result of gingival inflammation index and tooth sensitivity test, there was mild pain response in experimental group but it disappeared as time went by. Therefore, safety of the office bleaching gel containing 30% hydrogen peroxide was confirmed.

Interdisciplinary treatment of Class III malocclusion using mini-implant: problem-oriented orthodontic treatment / 대한치과교정학회지

Interdisciplinary treatment of Class III malocclusion with congenital missing of unilateral maxillary canine and anterior crossbite is discussed focusing on a problem-oriented treatment planning, treatment progress, and treatment result. Maxillary mini-implant provided anchorage for distalization of the maxillary right porsterior dentition. Mandibular mini-implants were used to distalize the whole mandibular dentition. Total treatment time was 17 months to achieve a successful treatment goal. Stable occlusion was maintained after 12 months of retention.

Cotransplanted Bone Marrow Derived Mesenchymal Stem Cells (MSC) Enhanced Engraftment of Hematopoietic Stem Cells in a MSC-dose Dependent Manner in NOD/SCID Mice

Transplantation of marrow-derived mesenchymal stem cells (MSCs), expanded by culture in addition to whole bone marrow, has been shown to enhance engraftment of human hematopoietic stem cells (HSCs). Our hypothesis was that there might be an optimum ratio range that could enhance engraftment. We examined the percent donor chimerism according to the ratio of HSCs to MSCs in non-obese diabetic/severe combined immunodeficiency (NOD/SCID) mice. We tested a series of ratios of co-transplanted CD34+-selected bone marrow cells, and marrow-derived MSCs into sublethally irradiated NOD/SCID mice. In all experiments, 1 x 10(5) bone marrow derived human CD34+ cells were administered to each mouse and human MSCs from different donors were infused concomitantly. We repeated the procedure three times and evaluated engraftment with flow cytometry four weeks after each transplantation. Serial ratios of HSCs to MSCs were 1:0, 1:1, 1:2 and 1:4, in the first experiment, 1:0, 1:1, 1:2, 1:4 and 1:8 in the second and 1:0, 1:1, 1:4, 1:8 and 1:16 in the third. Cotransplantation of HSCs and MSCs enhanced engraftment as the dose of MSCs increased. Our results suggest that the optimal ratio of HSCs and MSCs for cotransplantation might be in the range of 1:8-1:16; whereas, an excessive dose of MSCs might decrease engraftment efficiency.

Cotransplanted Bone Marrow Derived Mesenchymal Stem Cells (MSC) Enhanced Engraftment of Hematopoietic Stem Cells in a MSC-dose Dependent Manner in NOD/SCID Mice

Transplantation of marrow-derived mesenchymal stem cells (MSCs), expanded by culture in addition to whole bone marrow, has been shown to enhance engraftment of human hematopoietic stem cells (HSCs). Our hypothesis was that there might be an optimum ratio range that could enhance engraftment. We examined the percent donor chimerism according to the ratio of HSCs to MSCs in non-obese diabetic/severe combined immunodeficiency (NOD/SCID) mice. We tested a series of ratios of co-transplanted CD34+-selected bone marrow cells, and marrow-derived MSCs into sublethally irradiated NOD/SCID mice. In all experiments, 1 x 10(5) bone marrow derived human CD34+ cells were administered to each mouse and human MSCs from different donors were infused concomitantly. We repeated the procedure three times and evaluated engraftment with flow cytometry four weeks after each transplantation. Serial ratios of HSCs to MSCs were 1:0, 1:1, 1:2 and 1:4, in the first experiment, 1:0, 1:1, 1:2, 1:4 and 1:8 in the second and 1:0, 1:1, 1:4, 1:8 and 1:16 in the third. Cotransplantation of HSCs and MSCs enhanced engraftment as the dose of MSCs increased. Our results suggest that the optimal ratio of HSCs and MSCs for cotransplantation might be in the range of 1:8-1:16; whereas, an excessive dose of MSCs might decrease engraftment efficiency.

A Case of Enteropathy-Associated T-cell Lymphoma (EATL) Presenting Perforation after Chemotherapy for Primary Intestinal Lymphoma / 대한소화기내시경학회지

Intestinal T-cell lymphomas are fairly uncommon, and can sometimes be associated with enteropathy. Enteropathy-associated T-cell lymphoma (EATL) is commonly accompanied by a nonspecific mucosal ulceration, similar to that observed as a complication of celiac disease. The clinical course of EATL is quite unfavorable, and tends to have a generally poor prognosis. When a tumor invades the bowel wall and is treated with corticosteroids and chemotherapy, cell lysis with perforation often occurs, particularly in case of lymphoma. Recent data indicate that extensive resection may improve local control, and eliminate the risk of early mortality due to visceral perforation or hemorrhaging in unresected lesions during chemotherapy. Here, we report the case of a 51-year-old male who was diagnosed with primary gastrointestinal lymphoma after colonoscopy, and presented with EATL after emergent exploratory laparatomy. We also include a review of the literature regarding this uncommon entity.

Hematologic Characteristics and Hemoglobin Fraction Analysis by High Performance Liquid Chromatogaphy in Patients with Hypochromic Microcytosis: Trials for Detection of beta-thalassemia / 대한진단검사의학회지

BACKGROUND: In Korea, more than 20 cases of beta-thalassemia have been reported up to date. To detect -thalassemia. Hemoglobin (Hb) fractions were measured in patients with hypochromic microcytosis, and we analyzed the hematological characteristics of these patients. METHODS: Among 359, 369 CBCs performed at Asan Medical Center, 229 patients (0.064%) showed hypochromic microcytosis with less than 75 fL of mean corpuscular volume (MCV), less than 24 pg of mean corpuscular hemoglobin (MCH), and less than 18% of red cell distribution width (RDW). We analysed Hb fractions using high performance liquid chromatography (VARIANT(TM) Hemoglobin Testing System). Iron, total iron binding capacity (TIBC), ferritin, and reticulocyte counts were measured and medical history was searched on cases with Hb A2 and F fractions more than 3.5% and 2.0%, respectively. RESULTS: Among the 229 patients with hypochromic microcysis, 44 (19.2%) showed an increased level of Hb A2 and/or F fractions. With the exclusion of 28 patients (23 children <2 years old and 5 pregnant women), 16 (7.0%) showed a significantly increased level of Hb A2 and/or F. However, all 16 patients were diagnosed as having iron deficiency anemia based on their iron status and clinical findings. Three patients who had an increased level of Hb F at more than 5% needed a further study and follow-up to rule out the diagnosis of the hereditary persistence of the fetal hemoglobin. CONCLUSIONS: No thalassemia cases were found in the study. Incidence of beta-thalassemia should be very low, less than 1/359, 369 (0.00027%), in South Korea; a larger population should be screened to detect beta-thalassemia.

Maternal and Neonatal Predictors of Hematopoietic Potential of Umbilical Cord Blood Units / 대한혈액학회지

BACKGROUND: Umbilical cord blood (UCB) is a useful source for hematopoietic stem cells especially when HLA-matched donors are unavailable. UCB banking is expensive, however, because only a small fraction of cryopreserved units is used for transplantation. In order to make the criteria for selecting optimal UCB units at the time of collection, we examined the effects of maternal and neonatal factors on the laboratory parameters of hematopoietic potential of UCB units. METHODS: Total number of 1,692 UCB units processed in our UCB bank was analyzed to determine the effects of maternal and neonatal factors such as maternal age, birth weight, gestational duration, and sex of baby on the laboratory parameters of hematopoietic potential including the volume of UCB units and the numbers of total nucleated cells (TNC), mononuclear cells (MNC), and CD34+cells. RESULTS: Bigger babies yielded larger volumes of UCB, more TNC, MNC and CD34+cells. Babies of longer gestational duration also yielded higher numbers of TNC and MNC, but the number of CD34+cells was declined. No significant effect by maternal age was noticed on the volume of UCB, TNC, MNC, or CD34+cells. CONCLUSION: Optimal results would be obtained by selecting babies with weight equal to or more than 3,350g and gestational duration from 38 weeks through 39.7 weeks. These data may be used as important criteria for selecting UCB units for banking and cost-effective bank operation.

Chondrogenic Differentiation of Mesenchymal Stem Cells from Human Umbilical Cord Blood / 대한정형외과학회잡지

PURPOSE: The aim of this study was to demonstrate the existence of circulating mesenchymal stem cells (MSC) in the human umbilical cord blood (hUCB) and to evaluate the chondrogenic differentiation potential of hUCB-derived MSC in vitro. MATERIALS AND METHODS: Fifty hUCB harvests were cultured in media supplemented with 10% fetal bovine serum. The adherent fibroblast-like cells were characterized by immunophenotyping and induced to differentiate into chondrocytes in the pellet culture with and without BMP-6. This study performed RTPCR of the chondrogenic markers, Safranin-O stain and type II collagen immunohistochemical stain. RESULTS: The mononuclear cells isolated from hUCB formed adherent colonies with an attached wellspread fibroblast-like morphology. The cells positively expressed the MSC-related antigens, but did not express the hematopoietic, HLA-DR, endothelial, or osteoclast antigens and could be induced to differentiate into chondrocytes under proper stimulation. BMP-6 increased the size of the pellet and the mRNA levels for aggrecan, type II collagen and type IX collagen and enhanced the levels of proteoglycan synthesis during chondrogenic differentiation. CONCLUSION: The homogenous fibroblast-like cells developed in cultures from hUCB with chondrogenic differentiation potential were considered to be MSC. Furthermore, it was found that BMP-6 enhanced chondrogenic differentiation of the hUCB-derived MSC in the pellet culture.

Isolation, Characterization and Tri-lineage Differentiation of Mesenchymal Stem Cells from Human Umbilical Cord Blood / 대한정형외과학회잡지

PURPOSE: Human umbilical cord blood (hUCB) is well known for a good source of hematopoietic stem cells (HSCs). However, the presence of mesenchymal stem cells (MSCs) in hUCB is still not well approved by many authors. We hereby report the isolation and characterization of MSCs from hUCB, as well as their differentiation into osteogenic, chondrogenic and adipogenic lineages. MATERIALS AND METHODS: Mononuclear cells were isolated from each hUCB harvest (n=411) by density gradient centrifugation, and suspended in -minimum essential medium supplemented with 10% fetal bovine serum (FBS). The cell population was expanded by successive sub-cultivation under the same condition. The cell population that showed more than 1, 000-fold expansion at fifth to eighth passage was inspected with known surface antigens of MSCs and other cell lineage. The isolated MSCs were cultured in osteogenic, chondrogenic, and adipogenic condition to identify their potential to differentiate into different mesenchymal cell lineage. RESULTS: Ninety five out of 411 hUCB units (23.1%) generated the MSC-like cell population during initial cultivation. Nine cell populations (2.2%) showed more than 1, 000-fold expansion capacity at fifth to eighth passage. These cells positively expressed all known MSC-related antigens. They did not express any of myeloid, endothelial, or histo-compatibility antigens. All of the MSCs isolated showed the potential to differentiate into osteogenic, chondrogenic, and adipogenic lineages. CONCLUSION: Our study supports that hUCB does contain MSCs, which can be differentiated into different cell lineages. We believe hUCB will be a good source of MSCs with the advantage of availability and relative abundance. We think hUCB should not be considered as a medical waste, and it will serve as a good source of cells for tissue engineering and cellular therapy in the future.

Osteogenic Differentiation of Mesenchymal Stem/Progenitor Cells Developed in Cultures from Human Umbilical Cord Blood / 대한정형외과연구학회지

PURPOSE: To demonstrate the existence in human umbilical cord blood (hUCB) of circulating mesenchymal stem/progenitor cells(MSPC), the adherent cells developed in cultures from hUCB were characterized and induced to differentiate into osteoblasts. MATERIALS AND METHODS: Fifty hUCB harvests were cultured in the media supplemented with 10% fetal bovine serum. Homogeneously adherent fibroblast-like cells obtained during successive subcultivation were characterized by immunophenotyping analysis and induced to differentiate into osteoblasts. Reverse transcription-polymerase chain reaction of osteogenic markers, alkaline phosphatase (ALP) stain, and von Kossa stain were performed. RESULTS: The adherent fibroblast-like cells developed in cultures from hUCB positively expressed the MSPCrelated antigens, but, did not express the hematopoietic, HLA-DR, osteoclast, or endothelial antigens. These cells were well proliferated during successive subcultivation. Under osteogenic condition, these cells showed increased levels of osteogenic mRNAs and strong positivity in ALP and von Kossa stains at 4th week. CONCLUSION: The homogeneous fibroblast-like cells developed in cultures from hUCB were considered to be MSPC. Morphological and immunophenotypical characteristics of these cells were very similar to those of bone marrow-derived MSPC, and well differentiated into osteoblasts.

A Case of Congenital Factor XIII Deficiency Diagnosed by Semiquantitative Method / 대한혈액학회지

Factor XIII (fibrin stabilizing factor) has roles of stabilizing clot and cross-linking fibrin polymer, so the congenital factor XIII deficient patient has clot unstability and delayed bleeding episodes. We experienced a case of 11 years old girl who had experienced delayed umbilical healing, several episodes of intraabdominal and intracranial hemorrhage. But her coagulation screening studies with prothrombin time, aPTT (activated partial thromboplastin time), bleeding time showed normal value at each episode. These findings suggested typical features of congenital factor XIII deficiency. We used semiquantitative method to diagnose Factor XIII deficiency and quantify Factor XIII. We has treated her successfully with prophylactic fresh frozen plasma through plasmapheresis from two donors.

Inherited Risk Factors for Venous Thrombosis : A Single Institution Experience / 대한혈액학회지

BACKGROUND: Venous thromboembolism is a serious medical problem causing considerable morbidity and mortality. Risk factors of thrombosis are surgery, trauma, pregnancy, tumor, oral contraceptive as well as genetic risk factors (deficiencies of protein C, protein S, antithrombin III) though genetic risk factors were found in about 5 to 10% of cases. Recently, it is known that point mutations in the factor V gene and the prothrombin gene are common risk factors of idiopathic deep vein thrombosis (DVT) in Caucasian. But the frequency of these mutations in Asian population are reported lower than Caucasian's. We investigated the incidence of hereditary risk factors of venous thrombosis at single institution. METHOD: From April 1998 to June 1999, patients who were diagnosed as venous thromboembolism and under 50 years old were enrolled. All patients were requested for protein C, protein S (total, free), antithrombin III, APC resistance test, factor VIII activity, anticardiolipin antibody, lupus anticoagulant (LA), anti-beta2-glycoprotein-I (anti-beta2-GPI). Point mutations of factor V (Arg506->Gln, Arg306->Thr, Arg306->Gly, A4070G) and prothrombin G20210A allele mutation were checked by allele specific PCR amplification. RESULTS: Thirty-four patients (M:F=19:15, median age 38, 22-49) were diagnosed as DVT (7), pulmonary embolism with/without other site venous thrombosis (5/7), retinal vein occlusion (10), venous thrombosis of unusual site (5). Nine patients had past thrombosis history. One patient had familial DVT history. Thirteen patients had acquired risk factors of thrombosis. All the results of APC resistance test were within normal range. There was no single case of factor V mutations or prothrombin G20210A allele mutation. Three patients had positive anti-beta2-GPI and one patient had positive LA. We also found free protein S deficiency : 5/31, combined deficiency of free protein S and antithrombin III: 3/31. Twenty-five patients (73.5%) had elevated factor VIII (>150%). CONCLUSION: In this study, we couldn't detect factor V point mutations, prothrombin G20210A allele mutation in thromboembolic patients. But we found high prevalence of elevated factor VIII. Follow-up test for factor VIII and clinical observation for recurrent thrombosis are in progress.

Pattern of Von Willebrand Factor Antigen and Large Von Willebrand Factor Multimer in Myeloproliferative Disorder and Reactive Thrombocytosis / 대한혈액학회지

BACKGROUND: Von Willebrand factor (vWf) plays a crucial role in the early phase of hemostasis. Acquired von Willebrand disease (vWD) due to abnormalities of vWf multimers has been reported in patients with myeloproliferative disorders (MPD) who have high platelet counts. We compared the distribution of plasma vWf antigen and large vWf multimers in samples obtained from patients with MPD and reactive thrombocytosis (RT). Furthermore, we tried to find the relationship between the decrease of large vWf multimers in plasma and the bleeding complication. METHODS: Sixteen patients with MPD and twenty-five patients with RT with more than 600x103/microliter of platelets were included in the study. The numbers of platelets and leukocytes, platelet distribution width (PDW), mean platelet volume (MPV), platelet-large cell ratio (P-LCR), vWf : Ag and vWf multimers were measured. RESULTS: The mean values of platelets and leukocytes were 1,091x103/microliter, 82.9x103/ in MPD and 763x103/, 11.4x103/ in RT (P<0.05). Platelet parameters such as MPV,PDW, P-LCR were 11.2 fL, 10.2%, 28.6% in MPD, and 9.6 fL, 9.9%, 19.6% in RT (P<0.05). The levels of vWf : Ag and large vWf multimer were 120.8 U/dL, 13.8% in MPD and 184.3 U/ dL, 20.7% in RT (P<0.05). Large vWf multimers were decreased in 11 MPDs and 2 RTs. Bleeding diathesis appeared only in 2 MPDs with decreased large vWf multimers. Platelet or leukocyte count was inversely correlated with large vWf multimers, but vWf antigen was correlated with large vWf multimer. CONCLUSION: The findings of normal vWf antigen level and decreased percentage of large vWf multimers are more frequent in MPD than in RT, and the measurement of these parameters is useful to differentiate MPD from RT. Bleeding complication in the patients with MPD with decreased large vWf multimers might be prevented by correction of decreased large vWf multimers.

TNF-alpha, TGF-beta, and fibrinolytic parameters in tuberculous and malignant pleural effusions / 결핵

BACKGROUND: Residual pleural thickening(RPT) develops in about 50% of tuberculous pleurisy(PLTB). Some reports have suggested that elevated TNF-α and impaired fibrinolysis could be the cause of RPT, but until now, the mechanism and predictors of RPT have not been well known. TGF-β has been known to promote fibrogenesis and is increased in tuberculous pleural fluid(PF). PLTB and malignant pleurisy(PLMAL) manifest lymphocyte-dominant exudative pleural effusion, and it has clinical implications in the differentiation of the two diseases, based on the findings of pleural effusion. We performed this study to compare pleural fluid TNF-α, TGF-β, and fibrinolytic parameters between PLTB and PLMAL, and to find the predictors of RPT in PLTB. METHODS: Thirty-five PLTB and 14 PLMAL patients who were admitted to the Asan Medical Center from February 1997 to August 1999 were enrolled. All PLTB patients were prescribed a primary, short-course, anti-tuberculosis regimen. TNF-α, tissue plasminogen activator (tPA), plasminogen activator inhibitor 1 (PAI-1), plasminogen, α2-antiplasmin, and D-dimer were measured in both PF and PB, TGF-β was measured only in PF. Clinical characteristics, TNF-α, TGF-β, and fibrinolytic parameters were compared between patients with RPT less than 2 mm and patients with more than 2 mm of the thirty patients who completed the anti-tuberculosis treatment. RESULTS: The levels of TNF-α, tPA, PAI-1, plasminogen, α2-antiplasmin, and D-dimer in PF were higher than those in peripheral blood (PB) in PLTB, whereas only plasminogen, α2-antiplasmin, and D-dimer were higher in PF than in PB in PLMAL. Pleural fluid TNF-α, TGF-β, PAI-1, plasminogen, α2-antiplasmin were increased in PLTB compared with PLMAL, but these factors did not show any further advantages over ADA in differentiation between PLTB and PLMAL. TNF-α, TGF-β, and fibrinolytic parameters did not show any differences between patients with RPT less than 2 mm and patients with RPT more than 2 mm. CONCLUSION: Our data suggest that TNF-α, TGF-β, and fibrinolytic parameters may play some role for the development of RPT in PLTB, but they failed to predict the occurrence of RPT in PLTB. Also these parameters did not seem to have any advantages over ADA in differentiating between two diseases.

Diagnostic availability of the soluble transferrin receptor in iron deficiency anemia and anemia of chronic disease / 대한임상병리학회지

BACKGROUND: In diagnoses of iron deficiency anemia(IDA) and anemia of chronic disease(ACD), bone marrow examinations, the gold standard, are too invasive. Iron parameters such as serum ferritin, iron, and total iron binding capacity(TIBC), may be altered by perturbations as varied as infection, inflammation, and malignancy. Clinically, IDA may be the initial manifestation of an occult carcinoma of the gastrointestinal tract, thus noninvasive methods with high sensitivity are now required in detecting tissue iron deficiency. In this study, we investigated the diagnostic availability of the soluble transferrin receptor(sTfR) in differential diagnosis of IDA and ACD. SUBJECTS AND METHODS: Thirty eight patients with uncomplicated IDA(ferritin or =60.0 microgram/L), 7 patients with combined anemia(IDA+ACD, 12.0 microgram/L< OR = ferritin <60.0 microgram/L), and 20 normal controls were included in the study. The blood levels of sTfR, hemoglobin(Hb), RBC indices, serum ferritin, serum iron, and TIBC were measured and the transferrin saturation was calculated. The sTfR levels were compared with each other group. The correlations between iron parameters and the sTfR levels were investigated in each group. RESULTS: The sTfR receptor levels were significantly higher in uncomplicated IDA patients(56.2+/-19.8 nmol/L) than in normal controls(17.9+/-3.9 nmol/L) and uncomplicated ACD patients(15.3+/-7.5 nmol/L). No difference of the sTfR concentrations was observed between ACD patients and normal controls. In combined group, four of the 7 cases showed higher sTfR values than that of normal controls. Good inverse correlation was observed between Hb and sTfR levels in uncomplicated IDA group. There were no correlations between iron parameters and sTfR levels in the other groups. CONCLUSION: Because the sTfR level was not elevated in ACD and was significantly higher in IDA, blood determination of the sTfR levels may be a useful method in differential diagnosis of IDA and ACD. The sTfR is the most useful marker expressing the functional iron deficiency without being affected by chronic diseases. Because the sTfR levels were inversely correlated with Hb in IDA patients, the combined use of two parameters, ferritin and sTfR which are the indices of storage iron and functional iron respectively, may allow accurate definition of the entire range of body iron status.