Association between Mutation and Expression of TP53 as a Potential Prognostic Marker of Triple-Negative Breast Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: TP53, the most frequently mutated gene in breast cancer, is more frequently altered in HER2-enriched and basal-like breast cancer. However, no studies have clarified the role of TP53 status as a prognostic and predictive marker of triple-negative breast cancer (TNBC). MATERIALS AND METHODS: We performed p53 immunohistochemistry (IHC), nCounter mRNA expression assay, and DNA sequencing to determine the relationship between TP53 alteration and clinical outcomes of TNBC patients. RESULTS: Seventy-seven of 174 TNBC patients were found to harbor a TP53 mutation. Patients with missense mutations showed high protein expression in contrast to patients with deletion mutations (positivity of IHC: wild type vs. missense vs. deletion mutation, 53.6% vs. 89.8% vs. 25.0%, respectively; p < 0.001). TP53 mRNA expression was influenced by mutation status (mRNA expression [median]: wild type vs. missense vs. deletion mutation, 207.36± 132.73 vs. 339.61±143.21 vs. 99.53±99.57, respectively; p < 0.001). According to survival analysis, neither class of mutation nor protein or mRNA expression status had any impact on patient prognosis. In subgroup analysis, low mRNA expression was associated with poor prognosis in patients with a TP53 missense mutation (5-year distant recurrence-free survival [5Y DRFS]: low vs. high, 50.0% vs. 87.8%; p=0.009), while high mRNA expression with a TP53 deletion mutation indicated poor prognosis (5Y DRFS: low vs. high, 91.7% vs. 75.0%; p=0.316). CONCLUSION: Association between TP53 mutation and expression indicates a potential prognostic marker of TNBC; hence both DNA sequencing and mRNA expression analysis may be required to predict the prognosis of TNBC patients.

Feasibility of three-dimensional reconstruction and automated measurement of fetal long bones using 5D Long Bone

OBJECTIVE: To evaluate the feasibility of five-dimensional Long Bone (5D LB), a new technique that automatically archives, reconstructs images, and measures lengths of fetal long bones, to assess whether the direction of volume sweep influences fetal long bone measurements in three-dimensional (3D) ultrasound and 5D LB, and to compare measurements of fetal long bone lengths obtained with 5D LB and those obtained with conventional two-dimensional (2D) and manual 3D techniques. METHODS: This prospective study included 39 singleton pregnancies at 26+0 to 32+0 weeks of gestation. Multiple pregnancies, fetuses with multiple congenital anomalies, and mothers with underlying medical diseases were excluded. Fetal long bones of the lower extremities-the femur, tibia, and fibula were measured by 2D and 3D ultrasound, and 5D LB, by an expert and non-expert examiner. First, we analyzed the 3D ultrasound and 5D LB data according to 2 different sweeping angles. We analyzed intra- and inter-observer variability and agreement between ultrasound techniques. Paired t-test, interclass correlation coefficient, and Bland-Altman plot and Passing-Bablok regression were used for statistical analysis. RESULTS: There was no statistical difference between long bone measurements analyzed according to 2 different volume-sweeping angles by 3D ultrasound and 5D LB. Intra- and inter-observer variability were not significantly different among all 3 ultrasound techniques. Comparing 2D ultrasound and 5D LB, the interclass correlation coefficient for femur, tibia, and fibula was 0.91, 0.92, and 0.89, respectively. CONCLUSION: 5D LB is reproducible and comparable with conventional 2D and 3D ultrasound techniques for fetal long bone measurement.

Image Settings Affecting Nuchal Translucency Measurement Using Volume NT(TM) Software

PURPOSE: To evaluate the effects of the deviation from the mid-sagittal plane, fetal image size, tissue harmonic imaging (THI), and speckle reduction filter (SRF) on the measurement of the nuchal translucency (NT) thickness using Volume NT(TM) software. MATERIALS AND METHODS: In 79 pregnant women, NT was measured using Volume NT(TM). Firstly, the three-dimensional volumes were categorized based on the angle of deviation in 10degrees intervals from the mid-sagittal plane. Secondly, the operator downsized the fetal image to less than 50% of the screen (Method A) and by magnifying the image (Method B). Next, the image was magnified until the fetal head and thorax occupied 75% of the screen, and the NT was measured (Method C). Lastly, NT values were acquired with THI and SRF functions on, with each function alternately on, and with both functions off. RESULTS: The mean differences in NT measurements were -0.09 mm (p<0.01) between two-dimensional (2D) and a deviation of 31-40degrees and -0.10 mm (p<0.01) between 2D and 41-50degrees. The intraclass correlation coefficients (ICC) for 2D-NT and NT according to image size were 0.858, 0.923, and 0.928 for methods A, B, and C, respectively. The ICC for 2D-NT and NT with respect to the THI and SRF were 0.786, 0.761, 0.740, and 0.731 with both functions on, THI only, SRF only, and with both functions off, respectively. CONCLUSION: NT measurements made using Volume NT(TM) are affected by angle deviation from the mid-sagittal plane and fetal image size. Additionally, the highest correlation with 2D-NT was achieved when THI and SRF functions were used.

Effect of Lumbar Stabilization and Dynamic Lumbar Strengthening Exercises in Patients With Chronic Low Back Pain

OBJECTIVE: To compare the effects of lumbar stabilization exercises and lumbar dynamic strengthening exercises on the maximal isometric strength of the lumbar extensors, pain severity and functional disability in patients with chronic low back pain (LBP). METHODS: Patients suffering nonspecific LBP for more than 3 months were included prospectively and randomized into lumbar stabilization exercise group (n=11) or lumbar dynamic strengthening exercise group (n=10). Exercises were performed for 1 hour, twice weekly, for 8 weeks. The strength of the lumbar extensors was measured at various angles ranging from 0degrees to 72degrees at intervals of 12degrees, using a MedX. The visual analog scale (VAS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ) were used to measure the severity of LBP and functional disability before and after the exercise. RESULTS: Compared with the baseline, lumbar extension strength at all angles improved significantly in both groups after 8 weeks. The improvements were significantly greater in the lumbar stabilization exercise group at 0degrees and 12degrees of lumbar flexion. VAS decreased significantly after treatment; however, the changes were not significantly different between the groups. ODQ scores improved significantly in the stabilization exercise group only. CONCLUSION: Both lumbar stabilization and dynamic strengthening exercise strengthened the lumbar extensors and reduced LBP. However, the lumbar stabilization exercise was more effective in lumbar extensor strengthening and functional improvement in patients with nonspecific chronic LBP.

Recombinant influenza viruses as delivery vectors for hepatis B virus epitopes

PURPOSE: Neuraminidase (NA) of influenza virus contains stalk region that shows a great deal of variability in both amino acid sequence and length. In this paper, we investigated generation of recombinant influenza viruses that had hepatitis B virus (HBV) B cell epitopes in the NA stalk region as a dual vaccine candidate. MATERIALS AND METHODS: We used the WSH-HK reassortant helper virus for rescue of recombinant influenza virus containing HBV epitopes and reverse genetic protocol based on the use of micrococcal nuclease-treated virus cores for reconstitution of ribonucleoproteins. RESULTS: We successfully generated a chimeric influenza viruses which contained 22 amino acid peptides in the stalk region derived from the surface and pre-surface protein HBV. The growth kinetics of the recombinant viruses was investigated after infection of Madin-Darby canine kidney (MDCK) and Madin-Darby bovine kidney (MDBK) cells and the rIV-BVPreS virus showed higher titer than other viruses in MDCK cells. We also confirmed the presence of HBV epitopes in the chimeric viruses by enzyme-linked immunosorbent assay (ELISA) using anti-HBV polyclonal antibody. When the ratio of recombinant virus verse wild type virus was calculated by ELISA, recombinant viruses exhibited 2 fold higher values than the wild type virus. CONCLUSION: These results suggest that chimeric influenza virus which contained foreign antigens can be used as dual vaccine against both HBV and influenza viruses.

Reverse genetic platform for inactivated and live-attenuated influenza vaccine

Influenza vaccine strains have been traditionally developed by annual reassortment between vaccine donor strain and the epidemic virulent strains. The classical method requires screening and genotyping of the vaccine strain among various reassortant viruses, which are usually laborious and time-consuming. Here we developed an efficient reverse genetic system to generate the 6:2 reassortant vaccine virus from cDNAs derived from the influenza RNAs. Thus, cDNAs of the two RNAs coding for surface antigens, haemagglutinin and neuraminidase from the epidemic virus and the 6 internal genes from the donor strain were transfected into cells and the infectious viruses of 6:2 defined RNA ratio were rescued. X-31 virus (a high-growth virus in embryonated eggs) and its cold-adapted strain X-31 ca were judiciously chosen as donor strains for the generation of inactivated vaccine and live-attenuated vaccine, respectively. The growth properties of these recombinant viruses in embryonated chicken eggs and MDCK cell were indistinguishable as compared to those generated by classical reassortment process. Based on the reverse genetic system, we generated 6 + 2 reassortant avian influenza vaccine strains corresponding to the A/Chicken/Korea/MS96 (H9N2) and A/Indonesia/5/2005 (H5N1). The results would serve as technical platform for the generation of both injectable inactivated vaccine and the nasal spray live attenuated vaccine for the prevention of influenza epidemics and pandemics.

Inhibitory Effect of Continentalic Acid from Aralia continentalis on Streptococcus mutans Biofilm

In our present study, we investigated the effects of continentalic acid on Streptococcus mutans (S. mutans) biofilm. Methanol extract of Aralia continentalis (A. continentalis) was suspended in water and sequentially partitioned with CHCl3, ethyl acetate (EtOAc), and n-butanol (n-BuOH). The CHCl3 fraction showed the highest activity and an antibacterial compound against S. mutans was isolated from this preparation through various chromatography methods by bioassay guided fractionation. MS, 1H-NMR and 13C-NMR analysis showed that the active principle was continentalic acid which was confirmed to show significant inhibitory effects against S. mutans biofilm. These results may provide some scientific rationale for the traditional use these extracts for the treatment of dental diseases.

A case of maternally inherited diabetes and deafness with rhabdomyolysis / 대한내과학회지

mutation at position 3,243 in the mtDNA-encoded tRNALeu (UUR) gene is associated with the syndrome of maternally inherited diabetes and deafness (MIDD). It is a rare form of diabetes first described in 1992 characterized by maternal relatives with an early middle-aged onset of diabetes, bilateral sensorineural hearing loss, and a normal or low body mass index. A 37-year-old woman was admitted because of general weakness. She had diabetes mellitus (DM) and deafness. Her mother had DM, her second sister had DM and deafness, and her little brother had DM. The molecular genetic analysis identified the A3243G point mutation. In addition, rhabdomyolysis was diagnosed based on the initial laboratory findings and a whole-body bone scan. We report a case of MIDD with rhabdomyolysis due to a low carbohydrate intake and present it with a literature review.

A Case of Aortopulmonary Fistula Caused by a Huge Thoracic Aortic Aneurysm

Aortopulmonary fistula is an uncommon but often fatal condition resulting as a late complication of an aortic aneurysm. The most common cause is erosion of a false aneurysm of the descending thoracic aorta into the pulmonary artery, resulting in the development of a left-to-right shunt and leading to acute pulmonary edema and right heart failure. We report an our experience with aortopulmonary fistula as a rare complication associated with thoracic aortic aneurysm and high output heart failure.

A Survey for Understanding of Breastfeeding among Mothers with Chronic Hepatitis B Infection / 소아감염

PURPOSE: Breastfeeding should be recommended for infants born to mothers with chronic hepatitis B Infection after postexposure prophylaxis. However, high proportion of these mothers are reluctant to engage in breastfeeding in Korea. This survey was taken to identify the cause of that reluctance. Method:Questionnaires were given to mothers with chronic hepatitis B infection who were registered at the 'Hepatitis B Perinatal Transmission Prevention Program' operated by Korea Center for Disease Control and Prevention. They visited a community health center for blood sample collection and signed a consent paper. The questionnaires were sent to the mothers. Result:Among 839 mailed questionnaires, 114 were returned marked 'address unknown'. The overall reply rate was 17% (n=125). Among responders, 52% (n=62) were breastfeeding and 48% (n=60) were formula-feeding. The most influential factor for breastfeeding was the mother's own decision (75%) and the obstetrician's recommendation (17%). For formula- feeding mothers, their decisions were influenced by obstetricians (57%), and by their own thinking (28%). The relationship between breastfeeding and perinatal prophylaxis failure was recognized as 45% 'related' and 50% 'not-related'. A total of 91% of breastfeeding mothers replied that they will breast-feed again. Among formula-feeding mothers, 78% answered that they will breast-feed if they were known that 'there is no direct relationship between breastfeeding and perinatal prophylaxis failure'. Conclusion:Despite the fact that there is no direct relationship between breastfeeding and perinatal prophylaxis failure, many were reluctant to breast-feed. Healthcare professionals have influence over the mothers for decision making. It will be necessary to educate healthcare personnel so that they can make a conceptual change as well as to promote the fact to the general public.

A Case of Blue Rubber Bleb Nevus Syndrome / 대한소화기내시경학회지

Blue rubber bleb nevus syndrome is a rare disorder that's characterized by multiple venous malformations of the skin and gastrointestinal tract, and these lesions usually cause episodes of occult gastrointestinal hemorrhage and iron deficiency anemia. We report here on a case of a 57-year-old woman who presented with intermittent melena and multiple cutaneous venous malformations. The endoscopic and radiologic examinations show multiple bluish polypoid venous malformations on the gastrointestinal tract, retroperitoneum, liver, mediastinum and lung. We were able to diagnose her as suffering from blue rubber bleb nevus syndrome and we treated her with iron supplementation for anemia. We report this case along with a brief review of the relevant literature.

A Case of Liver Abscess Associated with Duodenal Perforation by a Toothpick / 대한소화기내시경학회지

The ingestion of foreign bodies into the gut is rather common. Most these foreign bodies are passed out spontaneously without complications. Our patient was hospitalized for fever, nausea and vomiting for one week. On the initial endoscopic examination, a toothpick was seen to be impacted in the wall of the duodenal bulb. Air bubbles were noted at the site where the toothpick was removed. The duodenal perforation was treated with endoscopic hemoclipping. Abdominal CT showed free air in the periduodenum and there was a liver abscess. Therefore, liver abscess associated with duodenal perforation by the toothpick was diagnosed. On the cytology of the aspirated materials from the liver abscess, sulfur granule formation was noted and hepatic actinomycosis was diagnosed. The liver abscess was successfully treated with CT-guided abscess drainage and antibiotics. We report here on an unusual case of a liver abscess associated with duodenal perforation by a toothpick, along with a review of the literature.

The effects of shortened dexamethasone administration on remission rate and potential complications during remission induction treatment for pediatric acute lymphoblastic leukemia / 소아과

PURPOSE: Due to its high potency against leukemic blasts, our institution has opted for the use of dexamethasone during acute lymphoblastic leukemia (ALL) remission induction, but in our most recent treatment protocol, CMCPL-2005, we shortened the length of steroid treatment from 4 to 3 weeks. We compared both the rates of remission induction and significant complications observed during induction with CMCPL-2005, with those noted for our previous protocol, CMCPL-2001. METHODS: We retrospectively reviewed the records of patients diagnosed with ALL from January, 2001 to December, 2006 at the Department of Pediatrics, St. Mary's Hospital, the Catholic University of Korea. Data concerning age, sex, WBC count at diagnosis, immunophenotype, cytogenetic traits, and risk group were collected for each patient. Results of remission induction treatment were compared between the two patient groups. Infection and other major complications resulting from treatment were investigated according to NCI toxicity criteria. RESULTS: A total of 141 and 88 patients received remission induction under CMCPL-2001 and CMCPL-2005 respectively. In the CMCPL-2001 group, 136 (96%) achieved complete remission while 82 (93%) achieved CR in the CMCPL-2005 group. Patients in the CMCPL-2005 group were more likely to undergo remission induction without experiencing major complications. However, with regards to steroid related toxicities such as infection, no significant differences were noted. CONCLUSION: We shortened the length of steroid administration from four to three weeks, yet found the remission induction rate to be comparable to that of our previous regimen. However, rates of steroid related toxicities such as infectious complications remain unchanged despite shortened exposure to dexamethasone.

Protection of Cardiomyocytes from Acute Ischemic Injury by Protein Kinase Cepsilon Expression

BACKGROUND AND OBJECTIVES: Ischemic injury is the most common and important cause of myocardial damage. Over past decades, a number of studies have identified a protective mechanism known as ischemic preconditioning, which can block or delay cell death from ischemic injury. Protein kinase C (PKC), especially theepsilonisoform has been proposed as a key factor in the signaling pathway of ischemic preconditioning. However, whether PKCepsilon expression in cardiomyocytes can offer such protection from acute ischemia has not been explored. MATERIALS AND METHODS: To demonstrate a direct effect of PKCepsilon expression, a lentiviral vector system was established. Using the lentiviral vector, PKCepsilon was introduced to neonatal rat ventricular myocytes (NRVM) cultured under ischemic conditions, and also to adult rat myocardium subject to left coronary artery ligation. RESULTS: Compared to control, PKCepsilon expression in cultured NRVM under ischemia resulted in preserved cell density and morphology, and a reduction in cell death (77.6+/-12.8% vs 58.1+/-7.2%, p<0.05). In adult rats, the infarcted area after coronary artery ligation was markedly reduced in myocardium injected with PKCepsilon vector compared to control (11.4+/-5.3% vs 20.5+/-11.3%, p<0.01). CONCLUSION: These results provide direct evidence that PKCepsilon is a central player in protection against cell death from acute ischemia.

Carthamus tinctorius L. Increases BMP-2 Gene Expression during Bone Fracture Healing in Rats

Carthamus tinctorius L.is known to improve fracture healing, and bone morphogenetic proteins (BMPs) are associated with the formation and healing process of bone. BMP-2 and BMP-7 are two of the most important BMPs during the bone healing process. Human osteosarcoma MG63 cells and rats were used to determine the effects of Carthamus tinctorius L. extract (CTE) on BMP-2 gene expression. BMP-2 gene expression by CTE treatment in human osteosarcoma MG63 cells was not different from the control group until 8 hours of incubation, but was significantly higher, by 31%, than that of the control group at 16 hr of incubation. Microscopic findings of the 9th rib 3 weeks after fracture showed typical rimming of the osteoblast and immature bone formation in control and CTE groups. BMP-2 gene expression by in situ hybridization was remarkably increased by a CTE-supplemented diet in the fracture group compared to the control group. In conclusion, Carthamus tinctorius L. increased BMP-2 gene expression in human osteosarcoma cells and fractured bone. But further studies would be needed to elucidate the effect of CTE on fracture healing in vivo because our results did not show any evidence of healing improvement histologically 3rd week after fracture.

Control of Influenza:Development of Live Vaccine

Although trivalent subunit vaccine has been available, the influenza vaccine has been under-utilized because of cumbersome route of vaccination and low level of protection. Therefore, there has always been a great need to develop live attenuated influenza vaccine which can be administered through nasal route and elicit better immunogenicity. Through conventional repeated passage at low temperature, a live influenza vaccine carrier could be established. By reassortant formation between the 'cold- adapted' vaccine carrier and virulent strains, a prototype of trivalent live influenza vaccine is developed. Influenza A virus was adapted to replicate at low temperature. Serial passage at progressively lower temperature (30degrees C, 27degrees C and 24degrees C)resulted in the generation of cold-adapted (ca), temperature-sensitive (ts) mutant and attenuation (att) phenotype. This strain was evaluated for their ability to protect mice from challenge with same subtype and different subtype of influenza A virus. The study showed that vaccination of mice with live attenuated influenza virus provided complete protection against homologous and heterologous virus challenge. We also evaluated therapeutic potential of ca influenza virus. The mice infected with ca virus before challenge with wild type viruses or infected with simultaneously showed reduced clinical symptoms suggesting potential therapeutic effects.

Control of Influenza:Development of Live Vaccine

Although trivalent subunit vaccine has been available, the influenza vaccine has been under-utilized because of cumbersome route of vaccination and low level of protection. Therefore, there has always been a great need to develop live attenuated influenza vaccine which can be administered through nasal route and elicit better immunogenicity. Through conventional repeated passage at low temperature, a live influenza vaccine carrier could be established. By reassortant formation between the 'cold- adapted' vaccine carrier and virulent strains, a prototype of trivalent live influenza vaccine is developed. Influenza A virus was adapted to replicate at low temperature. Serial passage at progressively lower temperature (30degrees C, 27degrees C and 24degrees C)resulted in the generation of cold-adapted (ca), temperature-sensitive (ts) mutant and attenuation (att) phenotype. This strain was evaluated for their ability to protect mice from challenge with same subtype and different subtype of influenza A virus. The study showed that vaccination of mice with live attenuated influenza virus provided complete protection against homologous and heterologous virus challenge. We also evaluated therapeutic potential of ca influenza virus. The mice infected with ca virus before challenge with wild type viruses or infected with simultaneously showed reduced clinical symptoms suggesting potential therapeutic effects.

The Explanation of Postoperative Change of Vertebral Rotation and Rib Hump Using 3 Dimensional Finite Element Scoliosis Model / 대한척추외과학회지

STUDY DESIGN: An analytical study using a mathematical 3-D finite element model for thoracic scoliosis. OBJECTIVE: To find the important kinematics and post-operative changes of the spine and rib cage, in the corrective surgery for scoliosis, using the rod derotation method. SUMMARY OF LITERATURE REVIEW: A conventional corrective surgery for scoliosis was performed, based on empirical knowledge, and an increase in the secondary postoperative change in the rib hump, and a shoulder level imbalance, were reported. However, no analytical data exists for the kinematics and optimal correction method. MATERIALS AND METHODS: A mathematical finite element model of a normal spine, including the rib cage, sternum, both clavicles and pelvis, was developed. Using geometric mapping, with standing radiographs and CT images, a 3-D FEM of scoliosis was reconstructed, after translating and rotating the 3-D FEM of a normal spine, with the amounts analyzed from 12 built-in digitized coordinate axes for each vertebral image. With this model, three elements; distraction, translation and derotation, in operative kinematics, were investigated by analyzing the Cobb angle, apical vertebrae axial rotation (AVAR) and thoracic kyphosis. A simulation of a segmental pedicle screw fixation, with rod derotation for scoliosis, was performed. The changes in the Cobb angle, kyphotic angle, AVAR and rib hump were compared after 0 degrees, 15 degrees, 30 degrees, 45 degrees, 60 degrees and 90 degrees rod derotations. RESULTS: In kinematics, the vertebral rod derotation of a major curve, without rod deformation, is less influential in the correction of scoliosis, simply causing an increase in the rib hump. During the simulation, the co-action of distraction and translation, during rod insertion, has a major impact on the decrease in the Cobb angle and in the maintenance of the kyphotic angle. However, after a 30 degrees rod derotation, a decrease in the kyphosis, and increases in the rib hump and AVAR were observed. CONCLUSIONS: The distraction and translation factors were more important in operative kinematics than the rod derotation. With excessive rod derotation, the Cobb angle progressively decreased, but increases in the secondary change in the rib hump and rotation of the apical vertebrae were found.

Evaluation of the Usefulness of ACS:CentaurTM for the Tests of Serum Cardiac Markers / 대한임상병리학회지

BACKGROUND: Early diagnosis of acute myocardial infarction (AMI) is essential for the patient's clinical course. Serum cardiac markers such as creatine kinase MB (CK-MB), myoglobin, and cardiac troponin I (cTnI) supply physicians with powerful methods of diagnosing AMI. We evaluated the usefulness of ACS:CentaurTM for the tests of cardiac markers. METHODS: We used three levels of control materials and 138 patient samples (AMI 49, cardiac diseases other than AMI 41, noncardiac diseases 48). We analyzed precision and linearity of CK-MB, myoglobin and cTnI using control materials. The cutoffs for the descrimination of AMI were determined using receiver operating characteristic (ROC) curve, and sensitivity and specificity of each marker were analyzed. RESULTS: Coefficients of variations (CVs) of within day precision and between day precision were below 4% except cTnI. Linearity analyses showed good results in all the three markers. The cutoffs were 3.7 ng/mL for CK-MB, 121.0 ng/mL for myoglobin and 0.4 ng/mL for cTnI. In the diagnosis of AMI, the sensitivities and specificities were 93.9% and 97.8% for CK-MB, 73.5% and 91.0% for myoglobin and 100.0% and 95.5% for cTnI, respectively. CONCLUSIONS: The tests of cardiac markers using ACS:CentaurTM showed satisfactory precision and linearity, and they are specific and sensitive in the diagnosis of AMI. So, ACS:CentaurTM is useful for the measurement of cardiac markers in the diagnosis of AMI.

Antiphospholipid Antibodies and Activated Protein C Resistance in Patients with Leg Ulcers / 대한피부과학회지

BACKGROUND: Antiphospholipid antibodies(APA) including anticardiolipin antibodies(ACA) are significantly associated with ulcerations of the leg. Moreover, resistance to activated protein C(aPC) may be an important risk factor in leg ulcerations. Until now, there has been no clinical investigation about the positivity of APA or resistance to aPC in patients with leg ulcers in Korea. OBJECTIVE: We investigated the positivity to APA and the presence of resistance to aPC in patients with leg ulcers in Korea. METHODS: Venous or arterial ultrasonic Doppler, semiquantitative assay for serum APA and functional analysis for aPC resistance were conducted in 32 patients with leg ulcers. RESULTS: 1. Of the 32 patients with leg ulcers, 34,3% had a positive APA. APA were more frequently associated with venous ulcerations of the leg than in subjects with leg ulcers of arterial or mixed origin. 2. aPC resistance based upon the functional analysis, occurred in 43.7% to 46.8% of leg ulcer patients. 3. Livedo reticularis (38.1%) and superficial thrombophlebitis (19.0%) were the most common cutaneous manifestations accompanied by leg ulcers in 21 APA-positive and/or aPC resistant patients. Deep vein thrombosis of extremities was the most common complication (47.6%) among the systemic thrombotic sequelaes in APA-positive and/or aPC resistant patients. CONCLUSION: APA positivity and aPC resistance may be relatively common anticoagulant defects among patients with leg ulcerations in Korea. APA positivity and aPC resistance should be considered important risk factors for the development of not only leg ulcers but also systemic thrornbotic complications.