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Although transfusion is a globally prevalent medical procedure, there are knowledge gaps among physicians due to inadequate education on this topic. Our study sought to evaluate the level of understanding and awareness among medical students at Soonchunhyang University College of Medicine, Asan, Korea regarding transfusion medicine and patient blood management (PBM). The findings revealed a critical need to strengthen areas of education related to alternative treatments for various types of anemia, the impact of underlying conditions on anemia, and the implementation of PBM strategies in non-emergency situations. This underscores the imperative need for expanded and improved educational programs to ensure optimal patient outcomes and the safe use of blood products.
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Background/Aims@#Chronic intestinal pseudo-obstruction (CIPO) is a clinically heterogeneous syndrome characterized by compromised peristalsis and intestinal obstruction. Variants of actin gamma 2 (ACTG2), a protein crucial for correct enteric muscle contraction, have been found in CIPO patients. The aim of this study is to examine the clinical features and ACTG2 variants in Korean patients with CIPO. @*Methods@#From January 1995 to August 2020, 12 patients diagnosed with CIPO were included and genetic analysis testing of ACTG2 was performed. @*Results@#Heterozygous ACTG2 missense variants were found in 6 patients (50.0%). The p.Arg257Cys variant was found in 3 patients, and p.Arg63Gln and p.Arg178His variants were found in 1 patient each. A novel variant, p.Ile193Phe, was found in 1 patient. Three patients were diagnosed at birth, 2 at the age of 1 year, and 1 at 3 years of age. Abnormal prenatal genitourinary ultrasonographic findings were found in all 6 patients; microcolon was found in 4 patients (66.7%), and megacystis in all 6 patients. The pathology showed abnormal ganglion cells as well as myopathic findings. All patients are dependent on total parenteral nutrition and are to date alive. @*Conclusions@#ACTG2 variants are commonly found in Korean patients with CIPO. In CIPO patients with megacystis and abnormal prenatal ultrasonography, genetic testing of ACTG2 should be considered. Molecular diagnosis of CIPO is more important than pathologic diagnosis.
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Background@#In Korea, there were issues regarding the use of immunoassays for anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies to detect infection. So, we compared antibody results of eight kinds of commercial immunoassays using clinical remnant specimens. @*Methods@#We compared the results of several immunoassay kits tested on 40 serum samples from 15 confirmed patients and 86 remnant serum samples from clinical laboratory.Eight kinds of IVD kits—four enzyme-linked immunosorbent assay, two lateral flow rapid immunochromatographic assays, and two chemiluminescent immunoassays with one RUO kit were tested. @*Results@#Among 40 serum samples from 15 coronavirus disease 2019 (COVID-19) patients, 35 yielded at least one positive result for detecting antibodies in the combined assessment. There were inconsistent results in 12 (28%) samples by single immunoassay. Forty samples collected in 2019 before the first COVID-19 Korean case showed negative results except for one equivocal result. @*Conclusion@#The discrepant results obtained with different immunoassay kits in this study show that serological assessment of SARS-CoV-2 by a single immunoassay requires caution not only in detecting infection but also in assessing immunologic status.
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Background@#In Korea, there were issues regarding the use of immunoassays for anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies to detect infection. So, we compared antibody results of eight kinds of commercial immunoassays using clinical remnant specimens. @*Methods@#We compared the results of several immunoassay kits tested on 40 serum samples from 15 confirmed patients and 86 remnant serum samples from clinical laboratory.Eight kinds of IVD kits—four enzyme-linked immunosorbent assay, two lateral flow rapid immunochromatographic assays, and two chemiluminescent immunoassays with one RUO kit were tested. @*Results@#Among 40 serum samples from 15 coronavirus disease 2019 (COVID-19) patients, 35 yielded at least one positive result for detecting antibodies in the combined assessment. There were inconsistent results in 12 (28%) samples by single immunoassay. Forty samples collected in 2019 before the first COVID-19 Korean case showed negative results except for one equivocal result. @*Conclusion@#The discrepant results obtained with different immunoassay kits in this study show that serological assessment of SARS-CoV-2 by a single immunoassay requires caution not only in detecting infection but also in assessing immunologic status.
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Background@#We recently introduced the Barricor (BD, Franklin Lakes, NJ, USA) plasma separation tube, which uses a mechanical separator instead of a gel. We evaluated the effects of using the Barricor tube in a stat (statin) laboratory on the results and turnaround time (TAT) of routine chemical tests. We verified the impact of Barricor tube on reducing TAT and providing results similar to those obtained using serum separator tubes (SSTs). @*Methods@#We collected venous blood samples from 166 outpatients in Barricor tubes and SSTs and measured 28 routine analytes using an AU5800 instrument (Beckman Coulter, Brea, CA, USA). TAT indexes were compared before and after using Barricor tube. @*Results@#Mean percent differences were 60 minutes decreased from 7.84% to 2.66%, which was approximately one-third of that for SST. The reduction in TAT was attributable to a decrease in centrifugation time. Incomplete clotting and repeated centrifugation, which occurred frequently when using SST, also decreased after using the Barricor tubes. @*Conclusions@#The Barricor tube is an alternative to SST for routine chemical tests in institutions aiming to reduce TAT, with clinically allowable differences in test results.
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The use of liquid chromatography-tandem mass spectrometry (LC-MS/MS) in clinical laboratories is increasing and is likely to expand into even more clinical venues in the future. Mass spectrometry is the standard method for analyte identification in the clinical chemistry field; however, differences in mass spectrometry protocols and handling affect the accuracy and reliability of these tests and prevent direct comparisons of results between laboratories. For example, the results of laboratories using LC-MS/MS methods are less likely to be reproducible than those of laboratories using conventional, automated methods. This is due to inadequate handling of the equipment and/or poor quality control after the implementation of the method, which may result in unnecessary medical expenditures or even adverse outcomes for the patients. Unfortunately, guidelines to monitor the accuracy of LC-MS/MS-based clinical tests are still lacking. In general, the quality control methods used in conventional clinical tests could also be applied to LC-MS/MS. However, additional quality control methods specific to LC-MS/MS techniques must be continuously employed to maintain the same quality level achieved during method development and verification. This report is intended to help clinical laboratories that operate LC-MS/MS improve the accuracy and reliability of their testing by providing guidance for quality assurance and improvement, based on a collection of existing guidelines and expert opinions from the literature.
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Subject(s)
Humans , Immunoassay , Indicators and Reagents , Mass Spectrometry , Methods , Pathology, Molecular , Spectrum AnalysisABSTRACT
Laryngotracheobronchitis (LTB) is a common disease in the pediatric population, and it is rarely caused by a fungal infection. Acute respiratory failure caused by fungal LTB mainly occurs in immunocompromised patients, and early diagnosis is closely associated with morbidity and mortality. However, an appropriate diagnosis is challenging for pediatricians because symptoms and signs of LTB caused by Aspergillus spp. are nonspecific. Here, we report a case of progressive respiratory failure caused by pseudomembranous LTB in a child with a suspicion of primary immunodeficiency and highlight the importance of an early investigation, especially in immunocompromised patients.
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Laryngotracheobronchitis (LTB) is a common disease in the pediatric population, and it is rarely caused by a fungal infection. Acute respiratory failure caused by fungal LTB mainly occurs in immunocompromised patients, and early diagnosis is closely associated with morbidity and mortality. However, an appropriate diagnosis is challenging for pediatricians because symptoms and signs of LTB caused by Aspergillus spp. are nonspecific. Here, we report a case of progressive respiratory failure caused by pseudomembranous LTB in a child with a suspicion of primary immunodeficiency and highlight the importance of an early investigation, especially in immunocompromised patients.
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BACKGROUND: Angiogenesis is important for the proliferation and survival of multiple myeloma (MM) cells. Bone marrow (BM) microvessel density (MVD) is a useful marker of angiogenesis and is determined by immunohistochemical staining with anti-CD34 antibody. This study investigated the prognostic impact of MVD and demonstrated the relationship between MVD and previously mentioned prognostic factors in patients with MM. METHODS: The study included 107 patients with MM. MVD was assessed at initial diagnosis in a blinded manner by two hematopathologists who examined three CD34-positive hot spots per patient and counted the number of vessels in BM samples. Patients were divided into three groups according to MVD tertiles. Cumulative progression-free survival (PFS) and overall survival (OS) curves, calculated by using Kaplan-Meier method, were compared among the three groups. Prognostic impact of MVD was assessed by calculating Cox proportional hazard ratio (HR). RESULTS: Median MVDs in the three groups were 16.8, 33.9, and 54.7. MVDs were correlated with other prognostic factors, including beta2-microglobulin concentration, plasma cell percentage in the BM, and cancer stage according to the International Staging System. Multivariate Cox regression analysis showed that high MVD was an independent predictor of PFS (HR=2.57; 95% confidence interval, 1.22-5.42; P=0.013). PFS was significantly lower in the high MVD group than in the low MVD group (P=0.025). However, no difference was observed in the OS (P=0.428). CONCLUSIONS: Increased BM MVD is a marker of poor prognosis in patients newly diagnosed with MM. BM MVD should be assessed at the initial diagnosis of MM.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Antigens, CD34/metabolism , Bone Marrow/metabolism , Disease-Free Survival , Immunohistochemistry , Kaplan-Meier Estimate , Microvessels/physiopathology , Multiple Myeloma/diagnosis , Neoplasm Staging , Neovascularization, Pathologic , Plasma Cells/cytology , Prognosis , Proportional Hazards Models , Regression Analysis , Risk FactorsABSTRACT
BACKGROUND: Busulfan, an alkylating agent administered prior to hematopoietic stem cell transplantation, has a narrow therapeutic range and wide variability in metabolism. We developed a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for rapid and accurate quantification of plasma busulfan. METHODS: Busulfan was separated and detected using an LC system containing a C18 column equipped with MS/MS. The sample was eluted with a mobile phase gradient for a total run time of 10 min. Plasma busulfan concentration was quantified against a 6-point standard curve in a multiple reaction monitoring mode at mass-to-charge (m/z) 264.1 > 151.1. Precision, recovery, matrix effect, linearity, detection capability, carryover, and stability were evaluated. The range of plasma busulfan concentration was obtained by analyzing samples from 9 children receiving busulfan. RESULTS: The coefficients of variation of within-run and within-laboratory precision were all below 5%. Recoveries were all within the range of 100-105%. Linearity was verified from 0 to 5,000 ng/mL. Limit of detection and limit of quantification were 1.56 and 25 ng/mL, respectively. Carryover rate was within allowable limits. Plasma busulfan concentration was stable for 2 weeks at -20degrees C and -80degrees C, but decreased by 25% when the plasma was stored for 24 hr at room temperature, and by <5% in 24 hr at 4degrees C. The plasma busulfan concentrations were between 347 ng/mL and 5,076 ng/mL. CONCLUSIONS: Our method using LC-MS/MS enables highly accurate, reproducible, and rapid busulfan monitoring with minimal sample preparation. The method may also enable safe and proper dosage.
Subject(s)
Child , Child, Preschool , Humans , Infant , Busulfan/blood , Chromatography, High Pressure Liquid/standards , Hematopoietic Stem Cell Transplantation , Quality Control , Reference Standards , Tandem Mass Spectrometry/standardsABSTRACT
No abstract available.
Subject(s)
Adult , Humans , Male , 5-Aminolevulinate Synthetase/chemistry , Anemia, Sideroblastic/genetics , Asian People/genetics , Base Sequence , Genetic Diseases, X-Linked/genetics , Hemizygote , Mutation, Missense , Polymorphism, Single Nucleotide , Republic of KoreaABSTRACT
BACKGROUND/AIMS: Several factors affecting the severity and outcomes of diverticulitis have been reported, but there is little research on physician specialty related with this disease. Therefore, we evaluated the clinical characteristics and outcomes of diverticulitis depending on physician's specialty. METHODS: Medical records of 239 patients, who had been hospitalized with first-diagnosed acute colonic diverticulitis at Kyung Hee University Hospital in Gang Dong (Seoul, Korea) from June 2006 to December 2012, were retrospectively analyzed. The patients were classified according to whether they had been managed by gastroenterologists or not. Clinical characteristics and treatment outcomes were compared between two groups. RESULTS: Of these 239 patients, 38 (15.9%) patients were treated by a gastroenterologist and 201 (84.1%) patients by a non-gastroenterologist. Clinical characteristics such as age, gender, body mass index, comorbidity, medication, laboratory results, recurrence and complication were not significantly different between two groups. However, right-sided diverticulitis predominated in the non-gastroenterologist group (79% vs. 91%, P=0.028). From the sub-group analysis of uncomplicated diverticulitis, intravenous antibiotics was used for a shorter period of time by gastroenterologists than non-gastroenterologists (3.3+/-1.9 days vs. 4.4+/-2.8 days, P=0.032). Multivariate logistic regression analysis showed that the 3 day administration of intravenous antibiotics significantly depended on the physician's specialty (odds ratio 7.984, 95% confidence interval 1.990-32.043, P=0.003). CONCLUSIONS: The results suggest that the duration of intravenous antibiotics for treating uncomplicated colonic diverticulitis was shortened by gastroenterology specialists without increasing operation or recurrence.
Subject(s)
Humans , Anti-Bacterial Agents , Body Mass Index , Colon , Comorbidity , Diverticulitis , Diverticulitis, Colonic , Gastroenterology , Logistic Models , Medical Records , Recurrence , Retrospective Studies , Specialization , Specialty Boards , Treatment OutcomeABSTRACT
BACKGROUND/AIMS: The purpose of this study was to determine whether preoperative carbohydrate antigen 19-9 (CA 19-9) levels can predict the stage of diseases or survival rate in patients with resectable colorectal cancer (CRC). METHODS: A total of 247 patients who underwent curative resections at Kyung Hee University Hospital at Gangdong between 2006 and 2011 were enrolled. We investigated the correlations of preoperative serum levels of CA19-9 with clinicopathological features of CRC. Receiver operative curve was constructed for evaluating the efficiency of the serum CA 19-9 levels in the stratifying stage of CRC. Survival analysis was performed with Kaplan-Meire method and log-rank test. Cox regression analysis was used for the multivariate analysis for survival. RESULTS: Abnormal level of serum CA 19-9 (>37 IU/mL) were associated with advanced T stage (P60 U/mL was an independent predictor of survival rate in the patients with TNM stage III CRC.
Subject(s)
Humans , Colorectal Neoplasms , Multivariate Analysis , Survival RateABSTRACT
BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is the most common method of enteral nutrition for patients who require long term artificial nutrition. PEG has been used as a method of nutritional support; however, improvement of nutritional support via PEG has not yet been reported. In this study, we analyzed the efficacy of nutritional support via PEG. METHODS: We conducted a retrospective analysis of 196 consecutive patients who underwent PEG at Kyung Hee University Hospital in Gang Dong from 2006 to 2012. We analyzed clinical characteristics, the method of nutritional support, and the proportion of intake to establish recommendations for nutritional requirements and the duration needed to reach the level of appropriate nutrition. RESULTS: A total of 196 patients included 130 men and 66 women, and their mean age (standard deviation) was 69.1+/-14.0 years. Compared with caloric and protein supplementation before PEG, 113 kcal (13.8% of baseline) and 4.8 g of protein (17.5% of baseline) could be additionally supplied with PEG (P=0.001, respectively). The number of patients who could take more than 90% of the recommended requirements of caloric and protein supplementation after PEG showed increased caloric and protein intake by 25.4% and 20.2%, respectively, in comparison with those before PEG (P=0.001 and P=0.001, respectively). The mean duration of catch-up for more than 90% of the recommended caloric and protein intake was approximately 11 days. Procedure related complications and early mortality were reported in 8.1% and 0% of patients, respectively. CONCLUSIONS: PEG is an effective and safe nutritional support method for patients who require long term artificial nutrition.
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Female , Humans , Male , Endoscopy , Enteral Nutrition , Gastrostomy , Nutritional Requirements , Nutritional Status , Nutritional Support , Retrospective StudiesABSTRACT
No abstract available.
Subject(s)
Herpes Zoster , Herpes Zoster Ophthalmicus , Orbit , Orbital MyositisABSTRACT
PURPOSE: Although radiation-induced fibrosis is one of the common sequelae occurring after irradiation of skin and soft tissues, the treatment methods are not well standardized. This study aimed to establish the skin fibrosis mouse model by fractionated radiation for the further mechanism studies or testing the efficacy of therapeutic candidates. MATERIALS AND METHODS: The right hind limbs of BALB/c mice received two fractions of 20 Gy using a therapeutic linear accelerator. Early skin damages were scored and tissue fibrosis was assessed by the measurement of a leg extension. Morphological changes were assessed by H&E staining and by Masson's Trichrome staining. TGF-beta1 expression from soft tissues was also detected by immunohistochemistry and PCR. RESULTS: Two fractions of 20 Gy irradiation were demonstrated as being enough to induce early skin damage effects such as erythema, mild skin dryness, dry and wet desquamation within several weeks of radiation. After 13 weeks of irradiation, the average radiation-induced leg contraction was 11.1+/-6.2 mm. Morphologic changes in irradiated skin biopsies exhibited disorganized collagen and extracellular matrix fibers, as well as the accumulation of myofibroblasts compared to the non-irradiated skin. Moreover, TGF-beta1 expression in tissue was increased by radiation. CONCLUSION: These results show that two fractions of 20 Gy irradiation can induce skin fibrosis in BALB/c mice accompanied by other common characteristics of skin damages. This animal model can be a useful tool for studying skin fibrosis induced by radiation.
Subject(s)
Animals , Mice , Biopsy , Collagen , Contracts , Erythema , Extracellular Matrix , Extremities , Fibrosis , Immunohistochemistry , Leg , Models, Animal , Myofibroblasts , Nerve Fibers, Myelinated , Particle Accelerators , Skin , Transforming Growth Factor beta1ABSTRACT
Multiple sclerosis (MS) is an immune-mediated, inflammatory demyelinating disease of the central nervous system. The coexistence of multiple sclerosis and rheumatoid arthritis is very rare. This rare association is interesting due to the overlapping pathophysiological similarities of T-cells and tumor necrosis factor-alpha (TNF-alpha) in both diseases. We report a case of a Korean 10 year old girl with multiple sclerosis, who after 3 years developed a clinical and serological manifestation of juvenile rheumatoid arthritis.
Subject(s)
Humans , Arthritis, Juvenile , Arthritis, Rheumatoid , Central Nervous System , Demyelinating Diseases , Multiple Sclerosis , Sclerosis , T-Lymphocytes , Tumor Necrosis Factor-alphaABSTRACT
PURPOSE: Oral mucositis induced by radiotherapy to the head and neck area, is a common acute complication and is considered as the most severe symptom for cancer patients in the early stages of treatment. This study was proposed to establish the oral mucositis mouse model induced by a single dose of radiation for the facility of testing therapeutic candidates which can be used for the oral mucositis treatments. MATERIALS AND METHODS: Fifty-five BALB/c mice were divided into four groups: control, 16 Gy, 18 Gy, and 20 Gy. Oral mucositis was induced by a single dose of radiation to the head and neck using 6 MV x-Ray from linear accelerator. After irradiation, body weight and physical abnormalities were checked daily. Tongue tissues from all groups were taken on days 1, 2, 3, 5, 7, 9, and 14, respectively and H&E staining was conducted to examine morphological changes. RESULTS: Body weight dramatically decreased after day 5 in all irradiated mice. In the 16 Gy treatment group, body weight was recovered on day 14. The histology data showed that the thickness of the epithelial cell layer was decreased by the accumulated time after radiation treatment, up to day 9. Severe ulceration was revealed on day 9. CONCLUSION: A single dose of 16 Gy is sufficient dose to induce oral mucositis in Balb/C mice. Significant changes were observed in the Balb/C mice on days 7 and 9 after radiation. It is suggested that this mouse model might be a useful standard tool for studying oral mucositis induced by radiation.