Anti-phospholipase A2 receptor antibody as a prognostic marker in patients with primary membranous nephropathy Volume 37, Issue 3, September 2018, Pages 248–256

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Anti-phospholipase A2 receptor antibody as a prognostic marker in patients with primary membranous nephropathy

BACKGROUND: Phospholipase A2 receptor (PLA2R) has been identified as a major autoantigen in primary membranous nephropathy (MN). We evaluated the association between anti-PLA2R antibodies and clinical outcome in Korean patients with primary MN. METHODS: A total of 66 patients with biopsy-proven MN were included. Serum level of anti-PLA2R antibodies was measured by enzyme-linked immunosorbent assay. Biochemical parameters were estimated initially and at follow-up. RESULTS: Anti-PLA2R antibodies were detected in 52.1% and 27.8% of patients with primary and secondary MN, respectively. Forty-eight patients with primary MN were grouped based on presence or absence of anti-PLA2R antibodies. Proteinuria was more severe in anti-PLA2R-positive patients than in anti-PLA2R-negative patients (urine protein/creatinine ratio 7.922 ± 3.985 g/g vs. 4.318 ± 3.304 g/g, P = 0.001), and anti-PLA2R antibody level was positively correlated with proteinuria. The incidence of chronic kidney disease stage ≥ 3 was higher in anti-PLA2R-positive patients compared with anti-PLA2R-negative patients (P = 0.004). The probabilities of spontaneous remission were higher in anti-PLA2R-negative patients compared with anti-PLA2R-positive patients (P < 0.001). Multivariate analysis demonstrated that anti-PLA2R antibodies are an independent risk factor for developing chronic kidney disease stage ≥ 3 and for not reaching spontaneous remission. CONCLUSION: Detection of anti-PLA2R antibodies at diagnosis in patients with primary MN can predict prognosis and guide treatment decisions.

Effectiveness of a 5-year Community Oral Health Program for the Elderly in Korea / 치위생과학회지

Korea has been running the community oral health program for the elderly, including topical fluoride application and scaling. The aim of this study was to compare the subjective and objective oral health status of 345 participants according to the number of participants in the program and of 37 participants before and after the 5-year program. The survey consisted of an interview questionnaire and oral examinations. Analysis of variance was used to compare the variables of the 345 participants according to the numbers of participants. Paired t-test was used to compare the oral health statuses before and after the 5-year program in 37 subjects. There was no difference in subjective oral health status according to the number of participants in the oral health program in the elderly, including subjective health status, subjective oral health status, satisfaction with oral health, concern about oral health, need of dental treatment, oral pain, tooth sensitivity, subjective periodontal health, and subjective symptoms of periodontitis. The community periodontal index (CPI) of the 1 time participants was significantly higher than that of 3 times, 4 times or 5 times participants in the upper center, lower left, lower center, and lower right areas. There was a significant improvement in CPI from 2.59±1.14 to 1.41±1.54 (p<0.001) and positive oral behavioral change (daily tooth brushing frequency from 2.27±0.73 to 2.54±0.90) before and 5 years after the program. However, the program did not prevent tooth loss as the numbers of the remaining teeth significantly reduced from 23.77±1.84 to 21.95±2.03 over 5 years. We showed that running the community oral health program for the elderly for more than three years might have positive effects on the periodontal health of participants.

Oral Health Promotion Program for Elderly in Dong-gu, Daejeon: A Case Report / 치위생과학회지

The Ministry of Health and Welfare in Korea has enforced the oral health promotion program for elderly in Korea. There are the denture delivery program and the fluoride application-scaling program for elderly. Donggu Public Health Center in Daejeon has delivered the fluoride application- scaling program for elderly since the demonstration project in 2009. The official dental hygienists had a prior consultation with Dong-gu branch of Korean Senior Citizens Association in Daejeon. We expanded the program through government office, welfare centers, and nursing homes. The participants were satisfied with the public relations (95.2%), scaling (99.7%), fluoride application (91.5%), toothbrushing education (98.6%), and denture cleaning education (96.6%). After a medial accident with persistent bleeding, the pre-inspection survey about systemic disease and medication was reinforced. The official dental hygienists have agonized over the low participation of the low-income group and the overlap benefit with health insurance benefit of scaling. We suggested it be needed the assessment of the public oral health program to overlap with health insurance benefit.

Outcome of Cadaveric Kidney Transplantation from Expanded Criteria Donors / 대한내과학회지

BACKGROUND/AIMS: The Korean Network for Organ Sharing (KONOS) was established in 2000, and the KONOS criteria for expanded-criteria donors (ECD) have since been applied to kidney allocation from deceased donors. The outcome of cadaveric kidney transplantation from ECD according to KONOS criteria has not been investigated. METHODS: Seventy-seven cadaveric kidney transplants from January 2003 to December 2009 were recruited retrospectively. Factors that influence the glomerular filtration rate (GFR) of graft kidneys up to 36 months after transplantation were evaluated. Postoperative renal function and allograft and patient survival in the ECD group (n = 28) were compared with those in the standard-criteria donor (SCD) group (n = 49). RESULTS: The GFR of graft kidneys was different according to donor GFR, age, hypertension history, and cause of brain death. In the ECD group, GFR was lower than that in the SCD group by KONOS criteria. No differences in allograft or patient survival were observed until 3 years after kidney transplantation. CONCLUSIONS: Cadaveric kidney transplantation using the ECD by KONOS criteria is acceptable in term of graft and 3-year patient survival, although the GFR was lower in the ECD than in the SCD group.

A Case of Primary Hyperoxaluria with Renal Allograft Dysfunction / 대한신장학회지

Primary hyperoxaluria is a rare disorder of glyoxylate metabolism in which hepatic enzyme deficiencies result in overproduction of oxalate. The resulting elevation of urinary oxalate excretion leads to recurrent urolithiasis and progressive nephrocalcinosis. End-stage renal disease frequently occurs and is accompanied by systemic oxalate deposition along with its harmful effects. With the rarity and various clinical heterogeneity of the disease, the high proportion of patients in whom diagnosis is made after advanced renal failure have developed it. On account of its high rate of graft loss associated with primary hyperoxaluria, isolated kidney transplantation has been replaced by combined liver/kidney transplantation. In this report, we describe a case of primary hyperoxaluria with kidney graft failure who had a history of recurrent renal stones.

Successful treatment of refractory livedoid vasculitis with rituximab and cyclophosphamide / 대한내과학회지

Livedoid vasculitis (LV) is a chronic recurrent cutaneous disease that is characterized by a netlike vascular pattern of purpuric lesions that progress to ulcers and atrophic white scars. The etiology of LV is unknown. Various therapies have been used for LV with inconsistent results, including antiplatelet agents, fibrinolytics, anticoagulants, prostaglandin E1, and immunosuppressive agents, such as systemic corticosteroids, azathioprine, methotrexate, cyclosporine, and mycophenolate mofetil. We present a patient with idiopathic LV refractory to immunosuppressive therapy who had a good response to treatment with rituximab and cyclophosphamide.

Level of HOXA5 Hypermethylation in Acute Myeloid Leukemia is Associated with Short-term Outcome / 대한진단검사의학회지

Hypermethylation of the homeobox (HOX) gene promoter leads to decreased expression of the gene during tumor development and is thought to be correlated with the clinical outcome in leukemia. In this study, we performed pyrosequencing to quantify the methylation level of HOXA5 genes in the bone marrow samples obtained from 50 patients with AML and 19 normal controls. The methylation percentage of HOXA5 in AML patients (median=65.4%, interquartile range=35.9-72.3%) was higher than that of HOXA5 in control patients (median=43.1%, interquartile range=36.7-49.6%, Mann-Whitney U test, P=0.012). The patients of the AML group who had a high methylation percentage (>70%) had a good prognosis with a 3-yr overall survival (OS) of 82.5%, whereas the patients with a low methylation percentage (< or =70%) showed a 3-yr OS of 40.5% (P=0.048). Cox proportional hazards regression showed that the methylation percentages of HOXA5 were independently associated with the 3-yr OS of AML patients, regardless of their karyotypes. We propose that the quantification of HOXA5 methylation by pyrosequencing may be useful for predicting short-term prognosis in AML. However, the limitations of our study are the small sample size and its preliminary nature. Thus, a larger study should be performed to clearly determine the relationships among HOXA5 methylation levels, cytogenetics, and prognosis in AML patients.

A Case of Chylopericardium Secondary to the Superior Vena Cava Syndrome in Behcet's Disease / 대한류마티스학회지

Behcet's disease (BD) is a chronic inflammatory disorder associated with oral aphthous ulcer, genital ulcer and uveitis. Vascular lesions in BD can affect all types and sizes of vessels. The venous thrombosis, which is uncommon feature of other vasculitis, is relatively common clinical manifestation of BD. Sometimes the cardiovascular involvement in BD results in serious complications as the leading cause of morbidity and mortality. We report a 41-year-old male patient who suffered BD and presented massive chylopericardium due to the superior vena cava (SVC) syndrome. After thrombectomy of SVC, the highly productive left-sided chylothorax and restenosis of anastomosis site at SVC had occurred, which were successfully treated by the ligation of the thoracic duct and balloon-stent angioplasty. We discussed the mechanism and treatment of chylopericardium in SVC syndrome, and the possible complications after the surgical management.

beta ig-h3-Mediated Adhesion of Fibroblast-Like Synoviocytes in Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: beta ig-h3 is an extracellular matrix protein, which is overexpressed in synovial tissues of rheumatoid arthritis (RA) similar to adhesive glycoproteins. We sought to evaluate the compensatory role of beta ig-h3 with adhesive glycoproteins in mediating the adhesion of fibroblast- like synoviocytes (FLS) and to confirm the inhibitory effect of YH18 peptide of the 2nd fas-1 domain in beta ig-h3-mediated adhesion. METHODS: The adhesion of FLS isolated from synovial tissues of RA, was evaluated in 96 well microtiter plate coated with matrix proteins. Inhibitory effect of YH18 peptides from the 2nd and 4th fas-1 domains was estimated in beta ig-h3-mediated adhesion of FLS. RESULTS: The adhesion of FLS on beta ig-h3 was weaker than that of fibronectin and vitronectin. The beta ig-h3-mediated adhesion was enhanced by the stimulation with phorbol myristate acetate (PMA), but not by cytokines and growth factors. Combination of fibronectin with beta ig-h3 synergistically enhanced the adhesion of FLS, in contrast to the additive effect of vitronectin combined with beta ig-h3. YH18 peptide of the 2nd fas-1 domain did not block the beta ig-h3-mediated adhesion of FLS. CONCLUSION: Our results reveal that beta ig-h3 may regulate the adhesion of FLS through the interaction with adhesive glycoproteins and confirm that the essential motifs mediating adhesion on beta ig-h3 are different according to the type of cells.

A Case of Hypothenar Hammer Syndrome Presented as Digital Ulcerations / 대한류마티스학회지

Hypothenar hammer syndrome (HHS) is a non-atherosclerotic, non-inflammatory vascular disease that causes a digital ischemia as a result of the occlusion of distal ulnar artery adjacent to the hook of hamate. This syndrome is usually observed in men who use the hypothenar eminence of the hand to grip devices such as a hammer. As a consequence of repeated blunt trauma, the ulnar artery beneath hypothenar eminence may lead to pathologic changes, such as intima-medial hyperplasia and reactive inflammatory infiltrates, which lead to the digital ischemia. We experienced a case of HHS with digital ulcerations which occurred after intensive work with nail remover for 10 days. Selective angiography of right forearm showed complete occlusion of the ulnar artery at the level of hook of hamate with deficient superficial palmar arch. After treatment with intravenous prostaglandin E1 and heparin, the ulcerative lesions of fingers improved without surgical intervention, which implicates that medical management of HHS should be considered prior to the surgical treatment.

Reversible Posterior Leukoencephalopathy Syndrome in a Patient withSystemic Lupus Erythematosus Treated with Cyclosporine / 대한류마티스학회지

Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized clinically by headache, seizure, altered mental status and visual impairment. Neuroimaging shows reversible white matter edema predominantly in the parietal and occipital lobes. RPLS has been associated with a variety of conditions, including hypertensive encephalopathy, renal failure, immunosupressive therapy, and autoimmune diseases such as systemic lupus erythematosus (SLE). We report a young woman of SLE presented with headache, generalized tonic-clonic seizure and altered mental status, after taking azathioprine and cyclosporine. The brain magnetic resonance images showed bilateral hyperintensitiy in the posterior parietal, occipital, temporal lobes and cerebellum on T2-weighted images and fluid attenuated inversion recovery images, whereas diffusion-weighted images showed isointensity in the same distribution. The patient was improved clinically and radiologically one week after the control of hypertension and discontinuation of cyclosporine.

Antimicrobial Activities of Arbekacin against Recent Isolates of Staphylococcus aureus in Korean Hospitals / 대한임상미생물학회지

BACKGROUND: As clinical isolates of Staphylococcus aureus with reduced inhibition zone of arbekacin in disk diffusion susceptibility tests are observed frequently, we examined their susceptibility to the antibiotic by comparing the results of the agar dilution testing with those of disk diffusion testing. METHODS: During the period of May through July, 2004, 88 isolates of methicillin-resistant and 11 methicillin-susceptible S. aureus were collected from clinical specimens in Pusan National University Hospital and Kosin University Gospel Hospital. Minimal inhibitory concentrations (MICs) of arbekacin were determined by the agar dilution method, and inhibition zones by the disk diffusion method. RESULTS: All of the 99 isolates were tested susceptible to arbekacin by the agar dilution method (MIC < or = 8 mg/L). By the disk diffusion method, however, 5 isolates (5.1%) were intermediate (minor error) and 2 isolates (2.0%) resistant (major error). CONCLUSION: All isolates were susceptible to arbekacin, but the disk diffusion method showed 7 per cent of minor or major errors.

Identification of Proteome Molecules by Proteomics Using Two-Dimensional Gel Electrophoresis and MALDI-TOF MS / 감염

Genomic technologies have enabled rapid accumulation of information from complex biological systems over the last two decades. The complete DNA sequence is now known for many organism and the informational database obtained from genome sequencing projects has provide the base for the specification of proteome-the protein complement of genome. Genomic functions can be inferred from the analysis of gene structure and gene expression profiles because proteins are the functional molecules of an organism. Integrated technologies including protein separation, identification, characterization and information manage system are essential to analyze the proteins in complex cellular matrix. This study is focusing on the strategies of proteome analysis using sample preparation, 2-dimensional gel electrophoresis, processing of protein spots and identification of proteins, protein-protein interaction and posttranslational modification using MALDI-TOF-MS. 2-Dimensional gel electrophoresis is currently the most powerful protein separation technique and MALDI-TOF MS is powerful identification technique for protein and peptides as a sensitive, rapid, and high resolution analytical method. The developed integrated proteome technologies are very useful to understand the biological phenomena at molecular level by identifying the new molecules and their modifications in various cellular processes, and can be applied for biotechnology including medical science.