Comparison of RCF Scoring System to Clinical Decision for the Rey Complex Figure Using Machine-Learning Algorithm

Background@#and Purpose: Interpreting the Rey complex figure (RCF) requires a standard RCF scoring system and clinical decision by clinicians. The interpretation of RCF using clinical decision by clinicians might not be accurate in the diagnosing of mild cognitive impairment (MCI) or dementia patients in comparison with the RCF scoring system. For this reason, a machine-learning algorithm was used to demonstrate that scoring RCF using clinical decision is not as accurate as of the RCF scoring system in predicting MCI or mild dementia patients from normal subjects. @*Methods@#The RCF dataset consisted of 2,232 subjects with formal neuropsychological assessments. The RCF dataset was classified into 2 datasets. The first dataset was to compare normal vs. abnormal and the second dataset was to compare normal vs. MCI vs. mild dementia. Models were trained using a convolutional neural network for machine learning.Receiver operating characteristic curves were used to compare the sensitivity, specificity, and area under the curve (AUC) of models. @*Results@#The trained model's accuracy for predicting cognitive states was 96% with the first dataset (normal vs. abnormal) and 88% with the second dataset (normal vs. MCI vs. mild dementia). The model had a sensitivity of 85% for detecting abnormal with an AUC of 0.847 with the first dataset. It had a sensitivity of 78% for detecting MCI or mild dementia with an AUC of 0.778 with the second dataset. @*Conclusions@#Based on this study, the RCF scoring system has the potential to present more accurate criteria than the clinical decision for distinguishing cognitive impairment among patients.

Elevated levels of activated and inactivated thrombin-activatable fibrinolysis inhibitor in patients with sepsis / 대한혈액학회지

BACKGROUND: In sepsis, large scale inflammatory responses can cause extensive collateral damage to the vasculature, because both coagulation and fibrinolysis are activated unevenly. Thrombin-activatable fibrinolysis inhibitor (TAFI) plays a role in modulating fibrinolysis. Since TAFI can be activated by both thrombin and plasmin, it is thought to be affected in sepsis. Hence, activated and inactivated TAFI (TAFIa/ai) may be used to monitor changes in sepsis. METHODS: TAFIa/ai-specific in-house ELISA can detect only the TAFIa/ai form, because the ELISA capture agent is potato tuber carboxypeptidase inhibitor (PTCI), which has selective affinity towards only the TAFIa and TAFIai isoforms. TAFIa/ai levels in plasma from 25 patients with sepsis and 19 healthy volunteers were quantitated with the in-house ELISA. RESULTS: We observed increased TAFIa/ai levels in samples from patients with sepsis (48.7+/-9.3 ng/mL) than in samples from healthy individuals (10.5+/-5.9 ng/mL). In contrast, no difference in total TAFI concentration was obtained between sepsis patients and healthy controls. The results suggest that TAFI zymogen was activated and that TAFIa/ai accumulated in sepsis. CONCLUSION: The detection of TAFIa/ai in plasma could provide a useful and simple diagnostic tool for sepsis. Uneven activation of both coagulation and fibrinolysis in sepsis could be caused by the activation of TAFI zymogen and elevation of TAFIa/ai. TAFIa/ai could be a novel marker to monitor sepsis and other blood-related disturbances.

Evaluation of the Genotypes of the Lewis Blood Group in a Korean Population Using Direct Sequencing / 대한혈액학회지

BACKGROUND: The FUT2 and FUT3 genes determine the Lewis phenotype of red blood cells (RBCs). Recently, the Lewis genes, the secretor genes, and several mutations that cause Lewis negative and nonsecretor phenotypes have been identified. The purpose of this study was to analyze the gene frequency of FUT2 and FUT3 in a Korean population by comparing the use of the direct sequencing method to the use of the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method for mutation detection in the FUT2 and FUT3 genes. METHODS: RBCs and peripheral blood leukocytes were obtained from 225 apparently healthy volunteers to determine the phenotype and genotype of the FUT2 and FUT3 genes. Lewis phenotypes were determined on K3EDTA-stablized fresh blood samples using the column agglutination method. Lewis blood group genotyping was performed by use of the direct sequencing method. For the detection of T59G, C357T, and A385T mutations, the PCR-RFLP method was performed. RESULTS: The frequencies of the Lewis blood group phenotype were 12.4% for Le(a+b-), 70.7% for Le(a-b+), 11.1% for Le(a-b-) and 5.8% for Le(a+b+), respectively. Direct Sequencing of the FUT2 gene identified 92.2% C357T, 56.9% A385T, 0.4% G244A mutations and 1.8% del396. Direct Sequencing of the FUT3 gene identified 46.9% T59G, 30.4% G508A, 1.1% T202C, 1.1% C314T, 0.7% A1029G, 3.0% T1067A and 13.3% G1242A mutations. The PCR-RFLP method results were discordant in nine cases (1 case for C357T, 4 cases for A385T and 2 cases for T59G) as compared to the direct sequencing method results. CONCLUSION: We have determined the frequencies of FUT2 and FUT3 gene mutations in a Korean population. The use of the direct sequencing method was more accurate than the use of the PCR-RFLP method for the determination of the genotype of the FUT2 and FUT3 genes.

Human Prion Diseases

Transmissible Spongiform Encephalopathy (TSE) or prion diseases are fatal neurodegenerative diseases, which are caused by transmissible abnormal prion proteins, converting the endogenous normal prion in the body to the infectious abnormal prions. The most common form of human prion diseases is Creutzfeldt - Jakob disease (CJD). Most of CJD are sporadic with unknown cause. Some familial or iatrogenic CJDs are reported in many countries, but there have been no formally reported case in Korea. Variant CJD (vCJD) is a new form of human prion disease, which revealed differentiated clinical presentations and laboratory diagnostic results. vCJD was thought to be originated from eating the beefs or other parts of bovine spongiform encephalopathy (BSE) infected cattle. The unpredictable species barriers, the underestimated distribution of prion infected tissues, the variable clinical courses, and uncertain disease progressions of many prion diseases, all made the prion related risk assessment very difficult. Korea needs our own surveillance system for various prion diseases of human and animals and to make plans for the risk assessment of the various prion disease transmissions for the minimal spread by maximizing the research capacities.

Evaluation of a Blood Coagulation Factor XIII Assay Kit / 대한혈액학회지

BACKGROUND: Plasma coagulation factor XIII (FXIII) catalyzes the formation of covalent bounds between fibrin monomers, thus stabilizing the fibrin clot and increasing its resistance to fibrinolysis. Alteration of FXIII may contribute to bleeding, wound dehiscence and recurrent abortion. However, standard clotting tests cannot detect the FXIII deficiency. In this study, we evaluated a newly developed FXIII test kit (CoalinkTM, PeopleBio Inc., Seoul, Korea) in patients with various clinical conditions. METHODS: We evaluated the linearity and precision of the new FXIII test kit and compared the results of the new kit and the Pefakit FXIII assay. The FXIII was tested in idiopathic thrombocytopenic purpura (ITP) (n=40) patients, chronic renal failure (CRF) (n=20) patients, liver cirrhosis (LC) (n=40) patients, EDTA-induced pseudothrombocytopenia (EDTAIP) (n=10) patients, and in normal healthy persons (n=50). In the normal healthy persons, we determined a complete blood count (CBC), Ed-highlight-the second (n=50) is redundant. prothrombin time (PT) measurement and activated partial prothrombin time (aPTT) measurement and evaluated the results using the two assays. RESULTS: Serial dilution experiments with five samples provided good linearity (r2=0.9717). The intra- and inter assay precisions (CV) were 2.3~8.6% and 3.9~14.9%, respectively (n=20). There was a significant correlation between the use of the new kit and the Pefakit FXIII assay (r=0.8798, n=50). The FXIII activities of the normal healthy persons, ITP, CRF, LC and EDTAIP patients were 103.3+/-23.3%, 79.7+/-41.0%, 117.9+/-82.3%, 56.9+/-23.7% and 130.0+/-29.0%, respectively and they were significantly decreased in the ITP and LC patients (P<0.05). The rates below 80% of the FXIII level were 67.5% in the ITP patients, 90.0% in the LC patients, 35.0% in the CRF patients and 0.0% in the EDTAIP patients. FXIII activities were closely related to platelet count (r=0.832, P<0.05) and negatively correlated with PT (r=-0.389, P<0.05) and aPTT (r=-0.326, P<0.05). CONCLUSION: The new kit was determined to have good linearity and precision. Moreover, it was simple and rapid to perform. This method may prove useful for the evaluation of FXIII.

Expression of Angiopoietin-1 and Angiopoietin-2 mRNA in Eutopic and Ectopic Endometrium / 대한산부인과학회잡지

OBJECTIVE: To investigate the mRNA expression of Angiopoietin (Ang)-1 and Ang-2 in ectopic and eutopic endometrium from women with or without endometriosis throughout the menstrual cycle. METHODS: Total RNA was extracted and reverse transcribed into cDNA. The expression of Ang-1 and Ang-2 was examined by quantative competitive PCR (QC PCR) and each result was analyzed by Kruskal- Wallis analysis and Mann-Whitney U-test. RESULTS: The expression of Ang-1 mRNA was statistically significantly higher in endometrium of follicular phase from women with endometriosis compared to that from normal ones in the follicular phase. Endometriotic tissues expressed significantly lower Ang-2 mRNA compared to endometrium from women without endometriosis. CONCLUSION: We suggested that the expression of Ang-1 mRNA could be associated with the pathogenesis of endometriosis and might have a role as neovascularizaton and survival of ectopic endometrium.

A Case of Incidental Testicular Teratoma Found during Hydrocelectomy / 대한비뇨기과학회지

Testicular teratoma contains more than one germ cell layer in various stages of maturation and differentiation. The teratoma occurs at all ages but is most common in the 25-30 year age group. It is relatively infrequently seen in childhood and infancy. In these age group, teratoma is a benign tumor. Recently, we experienced one case of incidental testicular teratoma during hydrocelectomy in 22 month-old child, The hydrocele is frequently associated with teratoma under age 4 years and is the most common misdiagnosis. So we report this one case of testicular teratoma with review of related literatures.