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Purpose@#Prognostic Index for Natural Killer Lymphoma (PINK) is the most widely accepted prognostic model for patients withextranodal natural killer/T-cell lymphoma (ENKTL) treated with non-anthracycline–based therapy. We aimed to evaluate the prognostic implications of serum β-2 microglobulin (β2M) in the context of PINK and proposed a new prognostic model. @*Materials and Methods@#A total of 138 patients who were newly diagnosed with ENKTL and treated with non-anthracycline-based chemotherapy were identified. The cut-off value of high serum β2M was calculated by maximal-chi square methods (4.1 mg/L). A new prognostic model incorporating serum β2M into PINK was proposed and validated in an independent validation cohort (n=88). @*Results@#The patients’ median age was 53.5 years (range, 19 to 80 years). Patients with high serum β2M levels had significantly worse overall survival (OS) and progression-free survival (PFS). In multivariate analysis, high serum β2M was an independent adverse prognostic factor for OS. A new PINK-B (Prognostic Index for Natural Killer Lymphoma-serum β-2 microglobulin) model stratifiedpatients into three groups with distinct OS and PFS in the training cohort (3-year OS, 84.1% [95% confidence interval, 75.1 to 94.2], 46.8% [36.1 to 60.8] and 17.6% [6.3 to 49.2] for the low-, intermediate, and high-risk groups, respectively; 3-year PFS, 70.6% [59.4 to 83.8], 35.9% [25.9 to 49.8], and 7.35% [1.1 to 46.7] for the low-, intermediate-, and high-risk groups, respectively). The PINK-B model was further validated in an independent cohort. @*Conclusion@#Serum β2M is an independent prognostic factor for ENKTL patients. The new serum β2M-based prognostic model may be useful for identifying ultra-high-risk patients, and it can easily be adopted into daily clinical practice.
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Background/Aims@#The incidence of multiple myeloma (MM) in Korea is rapidly increasing. The diagnostic criteria of MM have been updated and novel therapeutic agents are available. This study explored the features of MM patients registered at Asan Medical Center (AMC) and the outcomes over the past 15 years. @*Methods@#Data were obtained from the AMC MM registry, which has been collecting the data of MM patients prospectively. The 774 MM patients included in our analysis were diagnosed from 2003, when thalidomide became available as a novel therapeutic agent, until April 2019. The 2-year survival rate of these patients was assessed. Patients were divided into two groups based on whether they were older or younger than 65 years, which is the cutoff age for the indication of autologous stem cell transplantation. Patients were also grouped according to the year of diagnosis: up to 2006, when bortezomib became available, and up to 2010, when the cost of lenalidomide was reimbursed. @*Results@#Patients < 65 years of age had better prognostic features, including a better performance, less advanced disease stage, and fewer abnormalities in their fluorescent in-situ hybridization (FISH) analysis results. A comparison of our Korean patients with patients registered in the Myeloma Related Disorder Registry data of Australia and New Zealand, showed ethnic discrepancies. The median overall survival of all patients was 3.7 years, with a 5-year survival rate of 41.8% and a 10-year survival rate of 23.4%. Survival progressively improved in patients diagnosed later. Age, performance status, renal function, C-reactive protein level, lactate dehydrogenase level, and cytogenetic findings were identified as significant prognostic factors. @*Conclusions@#This real-world survey revealed the clinical features and survival rates of patients at a tertiary Korean Hospital who were diagnosed with MM at the beginning of 21st century.
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Purpose@#We aimed to investigate the prognostic value of serum β2-microglobulin for patients with Burkitt lymphoma (BL) and to propose a risk-stratifying classification system. @*Materials and Methods@#A prospective registry-based cohort study of BL patients treated with dose-intensive or effective dose-adjusted chemotherapies (n=81) was conducted. Survival outcomes were compared based on previously reported risk groups and/or serum β2-microglobulin levels. A risk-stratifying classification system incorporating serum β2-microglobulin levels was proposed and validated in an independent validation cohort (n=60). @*Results@#The median age was 47 years, and 57 patients (70.4%) were male. Patients with high serum β2-microglobulin levels (> 2 mg/L) had significantly worse progression-free survival (PFS) and overall survival (OS) (p 2 mg/L) was independently associated with a shorter PFS (hazards ratio [HR], 3.56; p=0.047) and OS (HR, 4.66; p=0.043). The new classification system incorporating the serum β2-microglobulin level allowed the stratification of patients into three distinct risk subgroups with 5-year OS rates of 100%, 89.5%, and 62.5%. In an independent cohort of BL, the system was validated by stratifying patients with different survival outcomes. @*Conclusion@#Serum β2-microglobulin level is an independent prognostic factor for BL patients. The proposed β2-microglobulin–based classification system could stratify patients with distinct survival outcomes, which may help define appropriate treatment approaches for individual patients.
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Background/Aims@#The first autologous peripheral blood stem cell transplantation (ASCT) in Korea was performed for a small-cell lung cancer patient at Asan Medical Center (AMC) in 1993. Recently, lymphoma and myeloma have been the main indications; there has been progress in the treatments for these lymphoid malignancies. We explored the real-world experience of ASCT for lymphoma and myeloma at AMC over a 25-year period. @*Methods@#We used the AMC ASCT registry, which has collected ASCT data prospectively since January 1993. Data for Hodgkin lymphoma, non-Hodgkin lymphoma, and multiple myeloma patients were analyzed. Patients transplanted up to December 2018 were included to assess adequate survival data. The ASCT time period was divided arbitrarily into 1994-1999, 2000-2009, and 2010-2018. In cases of multiple myeloma, we analyzed the 1st ASCT data only. @*Results@#Survival of these lymphoid malignancy patients after ASCT has progressively improved. The increase in survival may be related to advances in various medical skills supporting ASCT. However, overall survival has improved much more than progression-free survival. This suggests that better salvage therapies after ASCT failure have mainly affected the improvement in overall survival. The hematopoietic cell transplantation-specific comorbidity index could not be used as a survival indicator in this analysis. @*Conclusions@#This real-world experience study showed that the survival of lymphoid malignancy patients treated with ASCT has improved over the past 25 years.
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Purpose@#We aimed to investigate the prognostic value of serum β2-microglobulin for patients with Burkitt lymphoma (BL) and to propose a risk-stratifying classification system. @*Materials and Methods@#A prospective registry-based cohort study of BL patients treated with dose-intensive or effective dose-adjusted chemotherapies (n=81) was conducted. Survival outcomes were compared based on previously reported risk groups and/or serum β2-microglobulin levels. A risk-stratifying classification system incorporating serum β2-microglobulin levels was proposed and validated in an independent validation cohort (n=60). @*Results@#The median age was 47 years, and 57 patients (70.4%) were male. Patients with high serum β2-microglobulin levels (> 2 mg/L) had significantly worse progression-free survival (PFS) and overall survival (OS) (p 2 mg/L) was independently associated with a shorter PFS (hazards ratio [HR], 3.56; p=0.047) and OS (HR, 4.66; p=0.043). The new classification system incorporating the serum β2-microglobulin level allowed the stratification of patients into three distinct risk subgroups with 5-year OS rates of 100%, 89.5%, and 62.5%. In an independent cohort of BL, the system was validated by stratifying patients with different survival outcomes. @*Conclusion@#Serum β2-microglobulin level is an independent prognostic factor for BL patients. The proposed β2-microglobulin–based classification system could stratify patients with distinct survival outcomes, which may help define appropriate treatment approaches for individual patients.
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L-ascorbic acid (L-AA; vitamin C) induces apoptosis in cancer cells. This study aimed to elucidate the molecular mechanisms of L-AA-induced apoptosis in human laryngeal epidermoid carcinoma Hep-2 cells. L-AA suppressed the viability of Hep-2 cells and induced apoptosis, as shown by the cleavage and condensation of nuclear chromatin and increased number of Annexin V-positive cells. L-AA decreased Bcl-2 protein expression but upregulated Bax protein levels. In addition, cytochrome c release from the mitochondria into the cytosol and activation of caspase-9, -8, and -3 were enhanced by L-AA treatment. Furthermore, apoptosis-inducing factor (AIF) and endonuclease G (EndoG) were translocated into the nucleus during apoptosis of L-AA-treated Hep-2 cells. L-AA effectively inhibited the constitutive nuclear factor-κB (NF-κB) activation and attenuated the nuclear expression of the p65 subunit of NF-κB. Interestingly, L-AA treatment of Hep-2 cells markedly activated Akt and mitogen-activated protein kinase (MAPK; extracellular signal-regulated kinase 1/2, p38, and c-Jun N-terminal kinase [JNK]) and and LY294002 (Akt inhibitor), SB203580 (p38 inhibitor) or SP600125 (a JNK inhibitor) decreased the levels of Annexin V-positive cells. These results suggested that L-AA induces the apoptosis of Hep-2 cells via the nuclear translocation of AIF and EndoG by modulating the Bcl- 2 family and MAPK/Akt signaling pathways.
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L-ascorbic acid (L-AA; vitamin C) induces apoptosis in cancer cells. This study aimed to elucidate the molecular mechanisms of L-AA-induced apoptosis in human laryngeal epidermoid carcinoma Hep-2 cells. L-AA suppressed the viability of Hep-2 cells and induced apoptosis, as shown by the cleavage and condensation of nuclear chromatin and increased number of Annexin V-positive cells. L-AA decreased Bcl-2 protein expression but upregulated Bax protein levels. In addition, cytochrome c release from the mitochondria into the cytosol and activation of caspase-9, -8, and -3 were enhanced by L-AA treatment. Furthermore, apoptosis-inducing factor (AIF) and endonuclease G (EndoG) were translocated into the nucleus during apoptosis of L-AA-treated Hep-2 cells. L-AA effectively inhibited the constitutive nuclear factor-κB (NF-κB) activation and attenuated the nuclear expression of the p65 subunit of NF-κB. Interestingly, L-AA treatment of Hep-2 cells markedly activated Akt and mitogen-activated protein kinase (MAPK; extracellular signal-regulated kinase 1/2, p38, and c-Jun N-terminal kinase [JNK]) and and LY294002 (Akt inhibitor), SB203580 (p38 inhibitor) or SP600125 (a JNK inhibitor) decreased the levels of Annexin V-positive cells. These results suggested that L-AA induces the apoptosis of Hep-2 cells via the nuclear translocation of AIF and EndoG by modulating the Bcl- 2 family and MAPK/Akt signaling pathways.
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BACKGROUND/AIMS: Indoxyl sulfate (IS) is a uremic toxin and an important causative factor in the progression of chronic kidney disease. Recently, paricalcitol (19-nor-1,25-dihydroxyvitamin D2) was shown to exhibit protective effects in kidney injury. Here, we investigated the effects of paricalcitol treatment on IS-induced renal tubular injury. METHODS: The fluorescent dye 2ʹ,7ʹ-dichlorofluorescein diacetate was used to measure intracellular reactive oxygen species (ROS) following IS administration in human renal proximal tubular epithelial (HK-2) cells. The effects of IS on cell viability were determined using MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assays and levels of apoptosis-related proteins (Bcl-2-associated protein X [Bax] and B-cell lymphoma 2 [Bcl-2]), nuclear factor-κB (NF-κB) p65, and phosphorylation of mitogen-activated protein kinase (MAPK) and protein kinase B (Akt) were determined by semiquantitative immunoblotting. The promoter activity of NF-κB was measured by luciferase assays and apoptosis was determined by f low cytometry of cells stained with f luorescein isothiocyanate-conjugated Annexin V protein. RESULTS: IS treatment increased ROS production, decreased cell viability and induced apoptosis in HK-2 cells. IS treatment increased the expression of apoptosis-related protein Bax, decreased Bcl-2 expression, and activated phosphorylation of MAPK, NF-κB p65, and Akt. In contrast, paricalcitol treatment decreased Bax expression, increased Bcl-2 expression, and inhibited phosphorylation of MAPK, NF-κB p65, and Akt in HK-2 cells. NF-κB promoter activity was increased following IS, administration and was counteracted by pretreatment with paricalcitol. Additionally, flow cytometry analysis revealed that IS-induced apoptosis was attenuated by paricalcitol treatment, which resulted in decreased numbers of fluorescein isothiocyanate-conjugated Annexin V positive cells. CONCLUSIONS: Treatment with paricalcitol inhibited IS-induced apoptosis by regulating MAPK, NF-κB, and Akt signaling pathway in HK-2 cells.
Subject(s)
Humans , Annexin A5 , Apoptosis , Cell Survival , Flow Cytometry , Fluorescein , Immunoblotting , Indican , Kidney , Luciferases , Lymphoma, B-Cell , Phosphorylation , Protein Kinases , Proto-Oncogene Proteins c-akt , Reactive Oxygen Species , Renal Insufficiency, Chronic , Signal TransductionABSTRACT
BACKGROUND: Multicentric Castleman's disease (CD) is commonly associated with poor prognosis, and well-known prognostic factors are scarce. We performed a retrospective analysis to define the clinical features and prognostic factors for patients with multicentric CD. METHODS: Between 1990 and 2013, 32 patients with multicentric CD were identified from the database of the Asan Medical Center, Seoul, Korea. Clinicopathologic data were collected by reviewing the medical records. With the exclusion of 4 patients because of unknown human immunodeficiency virus infection status, 28 human immunodeficiency virus-negative patients with multicentric CD were included in this analysis. RESULTS: Most of the patients were male (76%) and had a median age of 54 years. Hyaline vascular variant was the most common subtype (N=11, 39%). Hepatosplenomegaly (61%), fever (39%), edema (29%), and ascites (18%) were the most frequently reported symptoms and signs at diagnosis. With a median follow-up of 67 months, the 5-year overall survival (OS) was 77%. Patients with extravascular fluid accumulation (i.e., peripheral edema, ascites, and/or pleural effusions) were significantly associated with a poor survival rate (5-year OS, 94% vs. 56%; P=0.04). The extent of disease involvement was also a significant prognostic factor (5-year OS, 91% for involvement on a single side vs. 73% on both sides of the diaphragm; P=0.03). Other clinicopathologic factors were not significantly associated with patient survival. CONCLUSION: Our findings suggest that the hyaline vascular variant is not a rare subtype of multicentric CD. Extravascular fluid accumulation and disseminated disease involvement seem to be significant prognostic factors.
Subject(s)
Humans , Male , Ascites , Diagnosis , Diaphragm , Edema , Fever , Follow-Up Studies , Castleman Disease , HIV , Hyalin , Korea , Medical Records , Prognosis , Retrospective Studies , Seoul , Survival RateABSTRACT
BACKGROUND: Primary testicular diffuse large B-cell lymphoma (DLBCL) is a rare but aggressive extranodal lymphoma, and its relapse in the central nervous system (CNS) is a major concern during treatment. Despite this, the role of intrathecal prophylaxis in primary testicular DLBCL remains controversial. METHODS: We retrospectively reviewed the medical records of 14 patients with primary testicular DLBCL diagnosed between November 2000 and June 2012, and analyzed the CNS relapse rate in patients treated without intrathecal prophylaxis. Survival curves were estimated using the Kaplan-Meier method. RESULTS: The median age at diagnosis was 57 years (range, 41-79 years). Unilateral testicular involvement was observed in 13 patients. Nine patients had stage I, 1 had stage II, and 4 had stage IV disease. The international prognostic index was low or low-intermediate risk in 12 patients and high-intermediate risk in 2 patients. Thirteen patients underwent orchiectomy. All the patients received systemic chemotherapy without intrathecal prophylaxis, and prophylactic radiotherapy was administered to the contralateral testis in 12 patients. The median follow-up period of surviving patients was 39 months (range, 10-139 months). Median overall survival was not reached and the median progression-free survival was 3.8 years. Four patients experienced relapse, but CNS relapse was observed in only one patient (7.1%) with stage IV disease, 27 months after a complete response. CONCLUSION: Even without intrathecal prophylaxis, the rate of relapse in the CNS was lower in the Korean patients with primary testicular DLBCL compared to prior reports.
Subject(s)
Humans , Central Nervous System , Diagnosis , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Lymphoma , Lymphoma, B-Cell , Medical Records , Orchiectomy , Radiotherapy , Recurrence , Retrospective Studies , TestisABSTRACT
Femoroacetabular Impingement (FAI) arises from morphological abnormalities between the proximal femur and acetabulum. Impingement caused by these morphologic abnormalities induces early degenerative changes in the hip joint. Furthermore, FAI patients complain of severe pain and limited range of motion in the hip, but a guideline for treatment of FAI has not yet been established. Medication, supportive physical treatment and surgical procedures have been used in the treatment of the FAI patients; however, the efficacies of these treatments have been limited. Here, we report the diagnosis and treatment for 3 cases of FAI patients. Intra-articular (IA) steroid injection of the hip joint was performed in all three patients. After IA injection, pain was reduced and function had improved for up to three months.
Subject(s)
Humans , Acetabulum , Femoracetabular Impingement , Femur , Hip , Hip Joint , Injections, Intra-Articular , Osteoarthritis, Hip , Range of Motion, ArticularABSTRACT
In concert with the development of new materials in the last decade, the need for toxicological studies of these materials has been increasing. These new materials include a group of rare earths (RE). The use of RE nanotechnology is being considered in some green applications, to increase their efficiency by using nano-sized RE compounds, and therefore hazard evaluation and risk assessment are highly recommended. This review was conducted through an extensive contemplation of the literatures in toxicology with in vitro and in vivo studies. Major aspects reviewed were the toxicological evaluations of these elements and metallic compounds at the molecular and cellular level, animal and human epidemiological studies and environmental and occupational health impacts on workers. We also discuss the future prospect of industries with appliances using RE together with the significance of preventive efforts for workers' health. To establish a safe and healthy working environment for RE industries, the use of biomarkers is increasing to provide sustainable measure, due to demand for information about the health risks from unfavorable exposures. Given the recent toxicological results on the exposure of cells, animals and workers to RE compounds, it is important to review the toxicological studies to improve the current understanding of the RE compounds in the field of occupational health. This will help to establish a sustainable, safe and healthy working environment for RE industries.
Subject(s)
Animals , Humans , Biomarkers , Environmental Health , Epidemiologic Studies , Nanotechnology , Occupational Health , Risk Assessment , ToxicologyABSTRACT
BACKGROUND: Radioimmunotherapy agents have a highly significant role in autologous stem cell transplantation as they improve tolerability and increase the efficacy of the conditioning regimen. METHODS: We retrospectively analyzed the efficacy and toxicity of yttrium-90 ibritumomab tiuxetan (Zevalin) combined with intravenous busulfan, cyclophosphamide, and etoposide (Z-BuCyE) compared with those of BuCyE alone followed by autologous stem cell transplantation in patients with relapsed or refractory B-cell non-Hodgkin lymphoma (NHL). The efficacy, toxicity, and engraftment characteristics were compared between 19 patients who received Z-BuCyE and 19 historical controls who received BuCyE. RESULTS: The 2 treatment groups shared similar baseline characteristics. The median time to platelet engraftment (>20x10(9)/L) and neutrophil engraftment (>0.5x10(9)/L) did not significantly differ between the Z-BuCyE group (12 days and 10 days, respectively) and the BuCyE group (12 days and 10 days, respectively). No significant differences were observed between the groups with respect to toxicities and treatment-related mortality. The median follow-up period was 30.4 months, and median event-free survival was generally better in the Z-BuCyE group (12.5 months) vs. the BuCyE group (6.2 months, P=0.236). No significant difference in overall survival between the groups was noted. CONCLUSION: Adding ibritumomab tiuxetan to BuCyE high-dose chemotherapy may benefit patients with relapsed or refractory B-cell NHL with no risk of additional toxicity.
Subject(s)
Humans , Antibodies, Monoclonal , B-Lymphocytes , Blood Platelets , Busulfan , Cyclophosphamide , Disease-Free Survival , Etoposide , Follow-Up Studies , Lymphoma, Non-Hodgkin , Neutrophils , Radioimmunotherapy , Retrospective Studies , Stem Cell TransplantationABSTRACT
OBJECTIVES: The aim of this study was to evaluate the relationship between shift work and work-related injuries in a representative sample of Korean workers. METHODS: We used data from the Korean Working Condition Survey of 2006. The participants were 7,075 Korean workers 15 to 64 years of age. Logistic regression was employed to estimate the relationship between shift work and work-related injury using the SAS version 9.2 program. RESULTS: Shift work was significantly related to work-related injuries compared to non-shift workers(OR 2.40, 95% CI=1.65~3.48). When personal and occupational risk factors were accounted for, shift work had a statistically meaningful relationship with work-related injuries compared to non-shift work(OR 1.79, 95% CI=1.20~2.66). CONCLUSIONS: In this study, shift workers appear to have a higher risk of work-related injuries compared to non-shift workers. Work-related injuries in shift workers could be attributed to circadian rhythm disorder and sleep problems. Suitable arrangements that ensure flexible working times are needed for shift workers. Further study will be needed to identify and mitigate work-related injuries among shift workers.
Subject(s)
Humans , Chronobiology Disorders , Dietary Sucrose , Logistic Models , Phenothiazines , Risk FactorsABSTRACT
OBJECTIVES: Mental health and work efficiency are adversely affected by exposure to physical and chemical hazards in the workplace. This study is the first large scale evaluation of the relationship between physical and chemical hazard exposure in the workplace in relation to the mental health of Korean workers. METHODS: A national survey of a random sample of workers (n=10,043) was conducted between June and September 2006 in Korea. Physical and chemical hazards in the workplace were considered if exposure occurred over more than a quarter of the time spent at work. Mental health problems were defined as work-related depression, anxiety or insomnia. We analyzed whether physical and chemical hazards were independent risk factors for work-related mental health problems by multiple logistic regression analysis after adjusting for age, gender, employment type, education, occupation, duty schedule, work hours, smoking, and alcohol consumption. RESULTS: The mean age of surveyed workers was 42 years and 58% were male. A total of 7.8% of workers had work-related mental health problems. Exposure to high temperature, mist, fumes, dust, chemicals, and radiation were associated with an increased risk of work-related mental health problems. CONCLUSIONS: This study reaffirmed that physical and chemical hazard exposure in the workplace significantly elevates the risk of work-related mental health problems.
Subject(s)
Humans , Male , Anxiety , Appointments and Schedules , Depression , Dust , Employment , Hot Temperature , Korea , Logistic Models , Mental Health , Occupations , Risk Factors , Sleep Initiation and Maintenance Disorders , Smoke , Smoking , VibrationABSTRACT
OBJECTIVES: To date, no population-based epidemiological studies have estimated the association between physical workload (standing or walking, carrying heavy loads, carrying people, repetitive hand or arm movements, wearing protective equipment) and work-related back pain in Korea. The purpose of this study was to evaluate the relationship between physical workload and work-related back pain using a nationwide survey. METHODS: We analyzed data obtained from working men and women age 15 to 64 (n=10,043) who participated in the 2006 national working condition survey of random sample workers in Korea. Using both simple and multiple logistic regression analysis, the association between physical workload and work-related back pain was evaluated. RESULTS: Carrying heavy loads, repetitive hand or arm movements, and wearing protective equipment were associated with an increased risk of work-related back pain. CONCLUSIONS: This study identifies that an increased risk of work-related back pain related to the nature and intensity of the physical workload of the general working population in Korea. We also found a strong association between repetitive hand or arm movements and back pain.
Subject(s)
Female , Humans , Male , Arm , Back Pain , Hand , Korea , Lifting , Logistic Models , WalkingABSTRACT
OBJECTIVES: The aim of this paper is to assess the needs and roles of the Worker's Health Centers employed by small scale enterprises by investigating the requested services made to this type of Worker's Health Center. METHODS: The population of this research was taken from 1,145 business owners or managers of manufacturing companies employing less than fifty people in six industrial estates. Stratified sampling was used. Individual interviews were performed to assess the conditions and needs of these enterprises using a structured questionnaire and professional interviewers. RESULTS: According to the questionnaire survey, 941(82.2%) of the enterprises wish to use a Worker's Health Center. 946(83.3%) of the enterprises preferred an 'Expert visit to the enterprise or mixed' for the Delivery type. 486(42.4%) of the enterprises preferred the 'in the center of industrial complex' for the location of the Worker's Health Center. 789(69.1%) of the enterprises preferred 6-10 PM for the available open hours. A multiple regression analysis revealed a significantly positive association regarding the intention of using a Worker's Health Center and the Gyeonggi-Banwol (OR 2.49) or Gwangju-Hanam(OR 4.24) for the region. Compared to enterprises employing 1-4 worker, 30-49 worker enterprises show a 3.33 fold preference (95% CI 1.80~6.12) for the use of a Worker's Health Center. CONCLUSIONS: Generally, the intention regarding the use of a Worker's Health Center was high, Considering the time and spatial limits inherentin small scale enterprises, the 'expert visit to the enterprise' paradigm is important. It should be noted that when providing the service, a customized approach is necessary, determined by size, region, industry, and scale of the business, through the assessment of the small scale enterprises and the nature of the work environment when designing a Worker's Health Center operation.
Subject(s)
Commerce , Delivery of Health Care , Intention , Surveys and QuestionnairesABSTRACT
BACKGROUND: Cytotoxic T lymphocytes (CTLs) appear to play an important role in the control and prevention of human cytomegalovirus (HCMV) infection. The pp65 antigen is a structural protein, which has been defined as a potential target for effective immunity against HCMV infection. Incorporation of an 11 amino acid region of the HIV TAT protein transduction domain (Tat) into protein facilitates rapid, efficient entry into cells. METHODS: To establish a strategy for the generation of HCMV-specific CTLs in vitro, recombinant truncated N- and C-terminal pp65 protein (pp65 N&C) and N- and C-terminal pp65 protein fused with Tat (Tat/pp65 N&C) was produced in E.coli system. Peripheral blood mononuclear cells were stimulated with dendritic cells (DCs) pulsed with pp65 N&C or Tat/pp65 N&C protein and immune responses induced was examined using IFN-gamma ELISPOT assay, cytotoxicity assay and tetramer staining. RESULTS: DCs pulsed with Tat/pp65N&C protein could induce higher T-cell responses in vitro compared with pp65N&C. Moreover, the DCs pulsed with Tat/pp65 N&C could stimulate both of CD8+ and CD4+ T-cell responses. The T cells induced by DCs pulsed with Tat/pp65 N&C showed higher cytotoxicity than that of pp65-pulsed DCs against autologous lymphoblastoid B-cell line (LCL) expressing the HCMV-pp65 antigen. CONCLUSION: Our results suggest that DCs pulsed with Tat/pp65 N&C protein effectively induced pp65-specific CTL in vitro. Tat fusion recombinant protein may be useful for the development of adoptive T-cell immunotherapy and DC-based vaccines.
Subject(s)
Humans , B-Lymphocytes , Cytomegalovirus , Dendritic Cells , Enzyme-Linked Immunospot Assay , HIV , Immunotherapy , T-Lymphocytes , T-Lymphocytes, Cytotoxic , tat Gene Products, Human Immunodeficiency Virus , VaccinesABSTRACT
BACKGROUND: The pain caused by injection of propofol is known to be related to the concentration of aqueous free propofol. Microemulsion propofol can cause a serious pain because it has 7 times higher concentration of aqueous free propofol. We used ondansetron, lidocaine, ondansetron lidocaine as pretreatment to compare the effect for injection pain of microemulsion propofol. METHODS: 75 patients, ASA physical status I or II were enrolled. We randomly allocated into Group L (n = 25) received 2% lidocaine 40 mg, group O (n = 25) received ondansetron 4 mg and group M (n = 25) received ondansetron 4 mg plus 2% lidocaine 40 mg as pretreatment. After instituting standard monitoring, the venous drainage was occluded using a pneumatic tourniquet at 25 cm proximal to venous line. The patients were pretreated over a period of 15 seconds with one of the pretreatment drug. After releasing the tourniquet, microemulsion propofol was injected. We asked the patient about degree of injection pain until loss of consciousness, by using 0-100 point pain intensity numerical rating scale (PI-NRS). In the recovery room, we asked the patient whether they recall injection pain. RESULTS: There were significant differences in the group L and the group M compared with group O on PI-NRS (P < 0.05). The incidence of injection pain was significantly lower in group L and group M than group O. CONCLUSIONS: Pretreatment of lidocaine and lidocaine + ondansetron is more effective than ondansetron alone for reducing pain on injection of microemulsion propofol.
Subject(s)
Humans , Drainage , Incidence , Lidocaine , Ondansetron , Propofol , Recovery Room , Tourniquets , UnconsciousnessABSTRACT
The Montgomery tracheal tube (T-tube) is a device used as a combined tracheal stent and airway after laryngotracheoplasty for patients with tracheal stenosis. This device can present various challenges to anesthesiologists during its placement, including the potential for acute loss of the airway, inadequate administration of inhalation agents, and inadequacy of controlled mechanical ventilation. The present case of successful airway management used a laryngeal mask airway under total intravenous anesthesia with propofol and remifentanil in the insertion of a Montgomery T-tube in a tracheal resection and thyrotracheal anastomosis because of severe subglottic stenosis.