T Cells Modified with CD70 as an Alternative Cellular Vaccine for Antitumor Immunity / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Successful tumor eradication primarily depends on generation and maintenance of a large population of tumor-reactive CD8 T cells. Dendritic cells (DCs) are well-known potent antigen-presenting cells and have applied to clinics as potent antitumor therapeutic agents. However, high cost and difficulty in obtaining sufficient amounts for clinical use are the crucial drawbacks of DC-based vaccines. Here, we aimed to develop T cell–based vaccine capable of eliciting potent antitumor therapeutic effects by providing effective costimulatory signals. @*Materials and Methods@#Antigenic peptide-loaded T cells transfected with retrovirus encoding costimulatory ligands CD70, CD80, OX40L, or 4-1BBL were assessed for antigen-specific CD8 T-cell responses and evaluated antitumor effects along with immunization of a mixture of synthetic peptides, poly-IC and anti-CD40 antibodies (TriVax). @*Results@#T cells expressing CD70 (CD70-T) exhibited similar level of stimulatory functionality and therapeutic efficacy as DCs. Moreover, CD70-T prime followed by TriVax booster heterologous vaccination elicited therapeutic antitumor effect against B16 melanoma where mediated by CD8 T cells but not CD4 T cells or natural killer cells. The combination with programmed death-ligand 1 blockade led to potent therapeutic efficacy which exhibited increased tumor-infiltrating CD8 T cells. CD70-T pulsed with multi-antigenic peptide generated multiple antigen-specific polyvalent CD8 T cells that were capable of inhibiting tumor growth effectively. Moreover, CD70-T vaccination resulted in higher expansion and migration of adoptively transferred T cells into tumor sites and elicits enhanced therapeutic effects with peptide-based booster immu-nization. @*Conclusion@#These results imply that T cells endowed with CD70 enable the design of effective vaccination strategies against solid cancer, which may overcome current limitations of DC-based vaccines.

Chemotherapy for Small Cell Carcinoma of Gallbladder: A Case Report / 대한췌담도학회지

Small cell carcinoma (SCC) of the gallbladder is a rare disease. It is an aggressive tumor that tends to metastasis early and is associated with poor prognosis. Median overall survival is reported to be approximately 13 months. Metastatic disease has a worse prognosis, and median overall survival is reported to be approximately 4 months. A 65-year-old male patient was diagnosed with the SCC of the gallbladder and was treated with cisplatin/etoposide chemotherapy followed by radiation therapy. Here, we describe the case of the SCC of the gallbladder who survived more than 3 years followed by the review of the literatures on this disease.

Acute Phlegmonous Gastritis Developing after Endoscopic Submucosal Dissection That Was Successfully Treated by Antibiotics Alone / 대한내과학회지

Endoscopic submucosal dissection (ESD) is widely used to treat a variety of gastric lesions including early gastric cancer and gastric adenoma. Bleeding and perforation are the most common complications of ESD. However, a rare and fatal bacterial stomach infection, termed acute phlegmonous gastritis, can also develop after ESD. We treated a patient with a high fever who complained of severe abdominal pain after ESD. Abdominal computed tomography (CT) revealed a diffuse, submucosal, minimally attenuated lesion and mucosal irregularity. The clincial presentation and the CT findings were compatible with acute phlegmonous gastritis and the patient was successfully treated with antibiotics alone. The case is worth reporting because acute phlegmonous gastritis is a very rare complication of ESD.

Septic Pylephlebitis as a Rare Complication of Crohn's Disease / 대한소화기학회지

Thrombophlebitis of the portal venous system (PVS) with superimposed bacterial infection (septic pylephlebitis) is an extremely rare complication of Crohn's disease (CD), and therefore diagnosis of septic pylephlebitis is difficult without high clinical suspicion. A 16-year old male patient who was diagnosed with CD 3 months earlier was admitted with recurrent fever and abdominal pain. CD activity had been well controlled with conventional medical treatment during a follow-up period. Abdominal contrast-enhanced computed tomography showed massive thrombosis in the PVS without evidence of intra-abdominal infection, and blood cultures were positive for Streptococcus viridians. There was no evidence of deep vein thrombosis or pulmonary thromboembolism, and all laboratory tests for thrombophilia were normal. Based on these findings, the patient was diagnosed with septic pylephlebitis complicated with CD, and was successfully treated with intravenous antibiotic therapy combined with anticoagulation. This case suggests that early comprehensive evaluation is crucial for immediate diagnosis and proper treatment of septic pylephlebitis in patients with CD who present with fever and abdominal pain of unknown origin, even with stable disease activity and absence of other intra-abdominal infections.

Recent trends in hepatitis B virus infection in the general Korean population

BACKGROUND/AIMS: Hepatitis B virus (HBV) is the major cause of chronic liver disease in Korea, but viral prevalence has decreased because of hepatitis B vaccination programs. In this study, we investigated longitudinal changes in HBV in fection in the general Korean population. METHODS: HBV surface antigen (hepatitis B surface antigen, HBsAg) seropositivity was assessed from the Korea National Health and Nutrition Examination Survey (I to V). In total, 50,140 subjects were tested for serum HBsAg positivity over a period of 12 years (1998 to 2010). RESULTS: The prevalence of HBsAg seropositivity decreased over the study period. The rates of HBsAg carriers were 4.61% in 1998, 4.60% in 2001, 3.69% in 2005, 3.01% in 2008, and 2.98% in 2010 (p 0.05). Neither gender nor socioeconomic status were associated with the decreased prevalence of HBsAg carriers. CONCLUSIONS: HBV infection has decreased in the Korean population since the advent of vaccination programs. However, the decrease is limited to the younger population, and viral persistence remains in the middle-aged and older population.

A Case of Aspiration Pneumonia with Acute Respiratory Distress Syndrome Following Aspiration of Polyethylene Glycol Solution Treated by Bronchoalveolar Lavage / 대한내과학회지

Colonoscopy requires adequate cleaning of the entire colon. Polyethylene glycol (PEG) is a popular laxative regimen because of the ease of applicability and optimal bowel preparation results. Although the safety and efficacy of this solution is well established, serious complications from the bowel PEG-cleansing procedure have been reported. Here, we report a case of a 79-year-old male who developed aspiration pneumonia with acute respiratory distress syndrome after administration of PEG by mouth before a scheduled colonoscopy. He was treated successfully with bronchoalveolar lavage and corticosteroids.

Predictors of Steroid Treatment Failure and Validation of Previous Models for Severe Attacks of Ulcerative Colitis

BACKGROUND/AIMS: Some clinical and laboratory parameter are predictors to determine steroid treatment failure in patients acute severe ulcerative colitis. We aimed to validate previous models in the Korean patients. METHODS: This study was conducted retrospectively with 70 patients who were diagnosed with severe ulcerative colitis (UC) between January 2001 and June 2011. The rate of treatment failure was investigated using predictors or numerical scoring systems from prior studies. RESULTS: Twelve (17.2%) patients failed to respond to steroid therapy. The logistic regression analysis revealed that stool frequency on the fifth day and colonic dilatation were the only independent predictive factors related to treatment failure. Formulated numerical risk scores based on mean stool frequency, colonic dilatation, and hypoalbuminemia were significantly higher in the non-responding group than those in the responding group (P8 than in the group with a score 8 plus CRP >4.5 mg/dL or bloody stool plus CRP >4.3 mg/dL) than those of the other group at the third day (40% vs. 7.3%, P=0.004; 33.3% vs. 5.2%, P=0.014, respectively). CONCLUSIONS: Stool frequency and CRP level were the meaningful parameters among the predictors for steroid treatment response. Furthermore, several predictive models for steroid treatment failure in western countries seem to be of value for use in the Korean population.

Liver Abscess Caused by Listeria monocytogenes : A Case Report / 감염과화학요법

Listeria monocytogenes has been recognized as a pathogen in elderly and immunecompromised hosts with malignancies, alcohol abuse, diabetes mellitus, transplanted organs, liver cirrhosis, renal failure, or acquired immunodeficiency syndrome (AIDS). In adults, it usually presents as neuromeningeal infection, such as meningitis, meningoencephalitis, or encephalitis, or as primary bacteremia. Involvement of the liver with L. monocytogenes is uncommon. We report on a case of multiple liver abscesses and bacteremia associated with L. monocytogenes in a 67-year-old diabetic female with concomitant active multidrug-resistant pulmonary tuberculosis. Blood cultures were positive for L. monocytogenes. In patients with liver abscess with advanced age or who are immune-compromised, including those with diabetes, clinicians should consider Listeria infection as a differential diagnosis.

A Case of Severe Hypercalcemia after Treatment with Teriparatide for Osteoporosis

Recombinant human parathyroid hormone 1-34 (rHPTH; 1-34, teriparatide) increases bone mass and increases osteoporotic fracture by stimulating new bone formation. It was approved in the United States for treatment of osteoporosis in men and women, and its effectiveness and safety was proved. Mild hypercalcemia was observed, but persistent and severe hypercalcemia was not observed in the studies of teriparatide. In this case, severe hypercalcemia was developed from patient having gait disturbance who was treated with vitamin D, calcium and teripartide for two months to treat osteoporosis after subtrochanteric fracture. Hypercalcemia was resolved with discontinuation of teriparatide. Severe hypercalcemia is not a common complication of teriparatide and monitoring of serum calcium level is routinely not recommended. But it is necessary to pay close attention to patients who were treated with teriparatide, especially in immobilized patients.

A Case of Severe Hypercalcemia after Treatment with Teriparatide for Osteoporosis

Recombinant human parathyroid hormone 1-34 (rHPTH; 1-34, teriparatide) increases bone mass and increases osteoporotic fracture by stimulating new bone formation. It was approved in the United States for treatment of osteoporosis in men and women, and its effectiveness and safety was proved. Mild hypercalcemia was observed, but persistent and severe hypercalcemia was not observed in the studies of teriparatide. In this case, severe hypercalcemia was developed from patient having gait disturbance who was treated with vitamin D, calcium and teripartide for two months to treat osteoporosis after subtrochanteric fracture. Hypercalcemia was resolved with discontinuation of teriparatide. Severe hypercalcemia is not a common complication of teriparatide and monitoring of serum calcium level is routinely not recommended. But it is necessary to pay close attention to patients who were treated with teriparatide, especially in immobilized patients.

A Case of Chronic Neuropathic Pseudo-obstruction of the Colon / 대한소화기내시경학회지

Colonic pseudo-obstruction, which is characterized by repetitive episodes or continuous symptoms and signs of a bowel obstruction, is a rare disease that results in colorectal dilatation without any obstructing lesions. Cases with neuropathic chronic colonic pseudo-obstruction have rarely been reported in Korea. We report a case of neuropathic colonic pseudo-obstruction, which results in decreased number of interstitial cells of Cajal and hypoganglionosis, in a 50-year-old man with chronic constipation accompanied by megacolon.