Establishment of a Maximum Surgical Blood Order Schedule and Red Blood Cell Mean Transfusion Units Per Patient According to Adjacent Diagnosis Related Groups Patient Classification System

Background@#For effective management of blood components, periodic updates of the maximum surgical blood order schedule (MSBOS) using recent data are crucial. This study aimed to establish an updated MSBOS and red blood cell (RBC) mean transfusion units per patient according to the adjacent diagnosis related groups (ADRG) classification system. @*Methods@#This retrospective study was based on an audit of the medical records of inpatients at a tertiary hospital between January and December 2017. We investigated transfusion-related data to establish the MSBOS and determine the RBC mean transfusion units per patient according to the ADRG and compared these updated values with previous data. @*Results@#During the investigated period, a total of 5,607 RBC units were transfused in 17,382 patients. The revised MSBOS was similar to the previous MSBOS in most surgeries. Among the 130 ADRG codes analyzed, 34 codes showed an increase, while 96 codes showed a decrease in RBC mean transfusion units per patient, compared to data from 2007. Overall, the RBC mean transfusion units per patient in 2017 was 0.89 units less compared to that in 2007 after adjusting for age (95% CI: 0.853–0.912). @*Conclusions@#The revised MSBOS was similar to that of the previous versions. However, there were differences in the number of RBC transfusion units used in some surgeries and disease treatments compared to those in the past. Considering the changes within the medical environment, this study highlights the importance of periodic evaluation of MSBOS and RBC transfusion usage.

Comparison of Clinical Utility between Phadiatop Assay and AdvanSureTM AlloScreen

Background@#Multiple Allergo-Sorbent Test (MAST) allows simultaneous detection of specific IgE antibodies using multiple allergens, and it is commonly used for allergy screening. Phadiatop assay (Phadia AB, Sweden), including Phadiatop test and Phadiatop Infant test, is a variant of specific IgE test that covers a mixture of common allergens. We compared the clinical utility of Phadiatop assay with that of the MAST AlloScreen (LG Life Science, Korea). @*Methods@#A total of 218 samples classified by AlloScreen results were collected. Phadiatop test was performed on sera from 61 and 103 aeroallergen-positive and -negative subjects. Phadiatop Infant test was performed on sera from 54 and 103 food and aeroallergen-positive and -negative subjects. When the results of AlloScreen and Phadiatop assay were not identical, we confirmed them using ImmunoCAP (Phadia AB). @*Results@#The concordance rate between AlloScreen and Phadiatop test was 93.2% (κ=0.86, P<0.001). Eleven (6.7%) of 164 specimens showed discrepant results. The results of AlloScreen did not agree with those of ImmunoCAP. The concordance rate between AlloScreen and Phadiatop Infant test was 97.4% (κ=0.945, P <0.001). Four (2.5%) specimens showed negative results in AlloScreen and positive results in Phadiatop Infant test. Three cases were confirmed as positive and one case was not confirmed through ImmunoCAP. @*Conclusions@#There was excellent agreement between AlloScreen and Phadiatop assay. Phadiatop assay accurately detected sensitization to common food and aeroallergen mixes. Therefore, Phadiatop assay is recommended as a screening test for allergic diseases.

Comparison of Clinical Utility between Phadiatop Assay and AdvanSureTM AlloScreen

Background@#Multiple Allergo-Sorbent Test (MAST) allows simultaneous detection of specific IgE antibodies using multiple allergens, and it is commonly used for allergy screening. Phadiatop assay (Phadia AB, Sweden), including Phadiatop test and Phadiatop Infant test, is a variant of specific IgE test that covers a mixture of common allergens. We compared the clinical utility of Phadiatop assay with that of the MAST AlloScreen (LG Life Science, Korea). @*Methods@#A total of 218 samples classified by AlloScreen results were collected. Phadiatop test was performed on sera from 61 and 103 aeroallergen-positive and -negative subjects. Phadiatop Infant test was performed on sera from 54 and 103 food and aeroallergen-positive and -negative subjects. When the results of AlloScreen and Phadiatop assay were not identical, we confirmed them using ImmunoCAP (Phadia AB). @*Results@#The concordance rate between AlloScreen and Phadiatop test was 93.2% (κ=0.86, P<0.001). Eleven (6.7%) of 164 specimens showed discrepant results. The results of AlloScreen did not agree with those of ImmunoCAP. The concordance rate between AlloScreen and Phadiatop Infant test was 97.4% (κ=0.945, P <0.001). Four (2.5%) specimens showed negative results in AlloScreen and positive results in Phadiatop Infant test. Three cases were confirmed as positive and one case was not confirmed through ImmunoCAP. @*Conclusions@#There was excellent agreement between AlloScreen and Phadiatop assay. Phadiatop assay accurately detected sensitization to common food and aeroallergen mixes. Therefore, Phadiatop assay is recommended as a screening test for allergic diseases.

Trends in Bloodstream Infections and Antimicrobial Susceptibilities at a University Hospital in Korea Between 2007 and 2016

BACKGROUND: Blood culture is an important method for identifying infectious microorganisms and confirming that a selected antimicrobial treatment is appropriate. In this study, we investigated the annual changes in the frequencies of blood isolates and antibiotic susceptibility test (AST) results. METHODS: We created a large database comprising data on all patient-unique blood cultures obtained from January 2007 through December 2016. Blood specimens were cultured using the BD BACTEC FX system, and species identification and AST were performed using the VITEK 2 system. RESULTS: During the 10-year study period, a total of 203,651 blood culture results were collected. Of these, gram-positive cocci, gram-negative rods, and fungi were isolated in 2.15%, 0.55%, and 0.12% of the blood cultures, respectively. Escherichia coli was the most commonly isolated species (22.8%), followed by Staphylococcus epidermidis (16.8%), Klebsiella pneumoniae (8.1%), and Staphylococcus aureus (8.0%). Fungal species were isolated in 3.0% of all positive blood cultures. Candida albicans was the most commonly isolated species (1.1%), followed by Candida parapsilosis (0.6%). Methicillin resistance was seen in 55.2% of S. aureus isolates. The frequencies of vancomycin-resistant Enterococcus (VRE) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) were 13.1% and 10.9%, respectively. The isolation rates of MRSA, VRE, and CRPA showed different patterns each year. CONCLUSIONS: Among the isolates, E. coli was the most common, followed by S. epidermidis and K. pneumoniae. This study represents a long-term analysis of bloodstream infections, and the results can be used to identify trends in the microorganisms isolated and their drug resistance.

The Relationship between Plasma Oxytocin Levels and Social Anxiety Symptoms

OBJECTIVE: The pathophysiology of social anxiety disorder (SAD) is not yet well understood, but previous research has suggested that oxytocin is associated with social behavior and may play a role in human anxiety states and anxiety-related traits. The aim of this study was to investigate the possible relationship between social anxiety symptoms and plasma oxytocin levels. METHODS: Twenty-three male patients with SAD and 28 healthy male controls participated in this study. All participants were assessed using the Mini International Neuropsychiatric Interview (MINI) and the Liebowitz Social Anxiety Scale (LSAS). Multivariate regression analysis was performed to identify associations between plasma oxytocin levels and SAD. RESULTS: In multiple regression models, after controlling for age and years of education, we found that higher oxytocin levels were significantly associated with higher total LSAS scores (R²=0.157, coefficient=0.145, 95% CI=-0.0005–0.291, p=0.051) and fear subscale scores (R²=0.134, coefficient=0.083, 95% CI=0.007–0.159, p=0.034) in the SAD group. CONCLUSION: In this study, increased plasma oxytocin levels were associated with higher social anxiety symptoms among SAD patients, but not among controls. This might be because among SAD patients, higher oxytocin (OT) secretion is an insufficient compensatory attempt to reduce social anxiety symptoms.

Mutation Analysis of X-linked Sideroblastic Anemia in a 12-Month-Old Boy by Massively Parallel Sequencing

No abstract available.

In Vitro Study Evaluating the Antimicrobial Activity of Vancomycin-Impregnated Cement Stored at Room Temperature in Methicillin-Resistant Staphylococcus aureus / 대한족부족관절학회지

PURPOSE: Treatment of diabetic foot infection due to methicillin-resistant Staphylococcus aureus (MRSA) remains challenging. Applying vancomycin-impregnated cement is one of the best methods of treatment. Vancomycin-impregnated cement has been used worldwide; however, to date, there is a limited number of studies regarding its use. We evaluated the duration of antimicrobial activity of vancomycin-impregnated cement stored at room temperature after manufacturing. MATERIALS AND METHODS: The vancomycin-impregnated cement was manufactured by mixing 1 g of vancomycin with 40 g of polymer and adding 17.90 g of liquid monomer. The cement dough was shaped into flat cylinders with diameter and height of 6 mm and 2 mm, respectively. Another cement of the same shape without mixing vancomycin was prepared as the negative control. All manufactured cements were sterilized with ethylene oxide gas and stored at room temperature. Each cement was placed on Mueller Hinton agar plate lawned with standard MRSA strain. Standard vancomycin disk and gentamicin disk were placed together. After 24 hours, the diameter of inhibition zone was measured, and if the diameter was less than 15 mm, vancomycin-impregnated cement was regarded as a loss of antimicrobial activity. The study was repeated every 2 weeks until vancomycin-impregnated cements lost their antimicrobial activity. RESULTS: Vancomycin-impregnated cement stored for a duration of 16 weeks created a 14 mm inhibition zone, while vancomycin disk created a 15 mm inhibition zone. Vancomycin-impregnated cement stored for a duration of 17 weeks created 7 mm and 9 mm inhibition zones, while vancomycin disk created 16 mm and 15 mm inhibition zones, respectively. CONCLUSION: We found a decrease of antimicrobial activity in vancomycin-impregnated cements after 16 weeks. After 17 weeks, they showed definite loss of antimicrobial activity. Therefore, we recommend not using vancomycin-impregnated cement spacers that has been stored for more than 16 weeks at room temperature.

Robinsoniella peoriensis Bacteremia: a Second Case in Korea

No abstract available.

Robinsoniella peoriensis Bacteremia: a Second Case in Korea

No abstract available.

First Case of Psychrobacter sanguinis Bacteremia in a Korean Patient / 대한임상미생물학회지

Psychrobacter sanguinis has been described as a Gram-negative, aerobic coccobacilli originally isolated from environments and seaweed samples. To date, 6 cases of P. sanguinis infection have been reported. A 53-year-old male was admitted with a generalized tonic seizure lasting for 1 minute with loss of consciousness and a mild fever of 37.8℃. A Gram stain revealed Gram-negative, small, and coccobacilli-shaped bacteria on blood culture. Automated microbiology analyzer identification using the BD BACTEC FX (BD Diagnostics, Germany) and VITEK2 (bioMérieux, France) systems indicated the presence of Methylobacterium spp., Aeromonas salmonicida, and the Moraxella group with low discrimination. The GenBank Basic Local Alignment Search Tool and an Ez-Taxon database search revealed that the 16S rRNA gene sequence of the isolate showed 99.30% and 99.88% homology to 859 base-pairs of the corresponding sequences of P. sanguinis, respectively (GenBank accession numbers JX501674.1 and HM212667.1). To the best of our knowledge, this is the first human case of P. sanguinis bacteremia in Korea. It is notable that we identified a case based on blood specimens that previously had been misidentified by a commercially automated identification analyzer. We utilized 16S rRNA gene sequencing as a secondary method for correctly identifying this microorganism.

Evaluation of Cobas b 101 HbA1c Analyzer Performance for Point-of-Care Testing

BACKGROUND: The use of point-of-care (POC) devices for evaluating HbA1c is increasing; accordingly, comparisons between these devices and central laboratory methods are important. In the present study, we evaluated the analytical performance of the cobas b 101 analyzer for POC HbA1c testing. METHODS: The analytical quality of the cobas b 101 system was assessed based on repeatability, within-laboratory precision, linearity, and lot-to-lot reproducibility. Two specimen types, i.e., EDTA whole blood and capillary blood, were examined using the cobas b 101 system and the Variant II Turbo instrument. RESULTS: The coefficient of variation for within laboratory precision was 5.22% for a normal HbA1c level and 2.56% for a higher HbA1c level. The method showed good linearity, with a coefficient of correlation of 0.990. In a comparison of two different HbA1c disk lots, a strong correlation (r=0.986) and a mean %difference of −2.9% were observed. The cobas b 101 results using EDTA whole blood were strongly correlated with the Variant II Turbo results (r=0.958), with a mean %difference of 0.8%; the cobas b 101 results using capillary blood were strongly correlated with the Variant II Turbo results, using EDTA whole blood (r=0.976), with a mean %difference of 2.0%. A comparison between HbA1c levels in EDTA whole blood and capillary blood obtained using the cobas b 101 showed a strong correlation (r=0.985) and a mean %difference of 1.3%. CONCLUSIONS: The cobas b 101 analyzer is convenient for the measurement of HbA1c levels for diabetes management.

Evaluation of Serum Cotinine Cut-Off to Distinguish Smokers From Nonsmokers in the Korean Population

BACKGROUND: Cotinine has been widely used as an objective marker to identify current smokers. We conducted this study to address the absence of Korean studies investigating the efficacy of immunoassays and liquid chromatography-tandem mass spectrometry (LC-MS/MS) for the detection of serum cotinine and to determine the optimal serum cotinine cut-off level for differentiating current smokers from nonsmokers. METHODS: Serum specimens were obtained from 120 subjects. They were randomly chosen to represent a broad distribution of urine cotinine levels based on a retrospective review of questionnaires and results of urine cotinine levels. We determined serum cotinine levels using the IMMULITE 2000 XPi Immunoassay System (Siemens Healthcare Diagnostics Inc., USA) and LC-MS/MS (API-4000, Applied Biosystems, USA). Correlation was analyzed between IMMULITE serum cotinine, urine cotinine, and LC-MS/MS serum cotinine levels. ROC curve was analyzed to identify the optimal IMMULITE serum cotinine cut-off level for differentiating current smokers from nonsmokers. RESULTS: IMMULITE serum cotinine levels correlated with both urine cotinine and LC-MS/MS serum cotinine levels, with correlation coefficients of 0.958 and 0.986, respectively. The optimal serum cotinine cut-off level for distinguishing current smokers from nonsmokers was 13.2 ng/mL (95.7% sensitivity, 94.1% specificity) using IMMULITE. CONCLUSIONS: This is the first study to investigate the use of LC-MS/MS for the measurement of serum cotinine and to determine the optimal serum cotinine cut-off level for the IMMULITE immunoassay. Our results could provide guidelines for differentiating current smokers from nonsmokers in the Korean population.

Human Epididymis Protein 4 as a Diagnostic Marker of Ovarian Cancer and Its Reference Interval in Korean Population

Human epididymis protein 4 (HE4), which complements cancer antigen 125 (CA125), has emerged as a new diagnostic biomarker that can discriminate between benign and malignant ovarian tumors. The risk of ovarian malignancy algorithm (ROMA) incorporates CA125, HE4, and menopausal status to classify patients with pelvic masses into those at high or low risk of developing ovarian cancer. The reference interval of HE4 among Korean population was different from those recommended by the manufacturer or evaluated in the Chinese.

Evaluation of Analytical Performance of the Cobas 8000 Analyzer Series Module e602

BACKGROUND: The e602, a module of the recently released cobas 8000 modular analyzer series, is an automated system for immunoassays. In this study, we evaluated its analytical performance using 17 immunoassay analytes. METHODS: The Clinical Laboratory Standards Institute guidelines were used to determine the efficiency of the cobas 8000 e602 based on its precision, linearity, assay comparison, and reference range validation. Performance analyses were completed using two levels of quality control materials and pooled sera from our institution. The performance of the cobas 8000 e602 was compared to that of the modular analytics E170. Statistical analyses were performed using Excel 2010 (Microsoft Co., USA) and EP Evaluator Release 10 (Data Innovations, USA). RESULTS: For all analytes, except level 1 total vitamin D, the coefficients of variation were 0.975 for all analytes. The reference range validation was also within the allowable criteria. CONCLUSIONS: Taken together, these findings demonstrate that the cobas 8000 e602 analyzer has good precision, linearity, performance comparison, and reference range validation. Thus, e602 is a useful module of the cobas 8000 modular analyzer series.

Identification of Mixed Lineage Leukemia Gene (MLL)/MLLT10 Fusion Transcripts by Reverse Transcription-PCR and Sequencing in a Case of AML With a FISH-Negative Cryptic MLL Rearrangement

No abstract available.

Therapeutic Plasma Exchange for a Patient with Severe Cold Agglutinin Disease / 대한수혈학회지

Cold agglutinin disease is a kind of autoimmune hemolytic anemia, caused by cold agglutinin, serum autoantibodies activated at reduced body temperatures to produce red blood cell agglutination and hemolysis. In this paper we described a case of severe hemolytic anemia in a cold agglutinin disease patient treated with therapeutic plasma exchange. Therapeutic plasma exchanges were performed four times every other day. Over the same period, a total of 8 units of washed red blood cells were transfused. Then hemoglobin was increased from 4.0 g/dL to 7.8 g/dL. On the 12th hospital day hemoglobin level was decreased again to 4.2 g/dL and fludarabine chemotherapy was started on the 14th hospital day. The patient's symptoms were relieved and she was discharged on the 30th hospital day. As in this case, therapeutic plasma exchange could be considered as secondary therapy for temporary improvement of acute severe hemolytic anemia in cold agglutinin disease.

Necrotizing Pneumonia and Empyema in an Immunocompetent Patient Caused by Nocardia cyriacigeorgica and Identified by 16S rRNA and secA1 Sequencing

No abstract available.

Acute Megakaryoblastic Leukemia with CD41a-/CD61-/CD42a+ Blasts in an Infant with Down Syndrome

Infants with Down syndrome have increased incidences of transient abnormal myelopoiesis (TAM) and acute leukemia, which are usually associated with acute megakaryoblastic leukemia (AMKL). A 5-day-old girl with Down syndrome was diagnosed with TAM; 4 months later, acute leukemic transformation was suspected. Bone marrow (BM) examination was performed, and the infant was diagnosed with acute leukemia (80% blasts). Although BM aspirates showed the presence of megakaryocytic blasts with cytoplasmic blebs, flow cytometry analysis revealed that they were negative for cells with CD41a and CD61 immunophenotypes. Further analysis revealed that the megakaryocyte-related marker CD42a was positive in 57% of blasts. Morphologic and immunophenotypic features are required to establish the lineage of megakaryocytic blasts, which are necessary for diagnosing AMKL. As most cases of AMKL were positive for CD41 and/or CD61 markers, their presence was evaluated during routine analysis. In order to identify the immunophenotypic features of AMKL in an infant with Down syndrome, we performed additional flow cytometry for CD42a, one of the megakaryocytic markers, and were able to assist in the early diagnosis of AMKL, as well as to use CD42a as an effective follow-up marker.

Analysis of Acute Myeloid Leukemia in Korean Patients with Sole Trisomy 6

No abstract available.

A Rare Case of Acute Leukemic Presentation of Blastic Plasmacytoid Dendritic Cell Neoplasm without Cutaneous Lesions

No abstract available.