Early-Onset Generalized Pustular Psoriasis of Pregnancy Following Hydroxychloroquine Use

Generalized pustular psoriasis of pregnancy (GPPP), characterized by widespread sterile pustules and erythematous patches with systemic symptoms such as fever, is a rare form of pustular psoriasis. GPPP typically occurs in the third trimester of pregnancy and can be triggered by various factors such as infections, hypocalcemia, and drugs including N-butyl-scopolammonium bromide. We report a rare case of new-onset GPPP in a 33-yearold multigravida female at 17 weeks’ gestation, which occurred earlier than usual, after taking hydroxychloroquine for 3 weeks to treat systemic lupus erythematosus. She stopped her medications and was treated with systemic corticosteroid, but without improvement.Her medication was changed to systemic cyclosporine; her skin lesions improved, which completely resolved after delivery. This is the first case of GPPP developed following hydroxychloroquine use for systemic lupus erythematosus, which occurred earlier than usual and completely resolved after delivery. This case demonstrates that hydroxychloroquine can induce GPPP before the third trimester of pregnancy.

Cutaneous Metastasis of Breast Cancer Showing Diffuse Purpuric Macules and Patches / 대한피부과학회지

Cutaneous and subcutaneous metastases from the neoplasm of visceral organs are uncommon and have been estimated to occur in only 0.7%∼9% of patients. Among these cases, breast cancer is the most frequently observed malignancy. The incidence of cutaneous metastasis of breast cancer is 23.9%. The most common clinical manifestation of cutaneous metastasis of breast cancer is non-fixed painless erythematous nodules on the anterior chest. However, cutaneous metastasis of breast cancer shows a wide range of clinical manifestations and can mimic benign dermatologic lesions such as erythema annulare centrifugum, contact dermatitis, cellulitis, and erysipelas. We report a 52-year-old woman who presented with diffuse purpuric macules and patches on the right trunk. Finally, based on the clinical and pathologic findings, a diagnosis of cutaneous metastasis of breast cancer was made, and the patient expired 1 year later.

Comparison of the effect of removing artificial dental plaque depending on various interdental cleaning products on the interdental surface of zirconia crowns / 대한치과보철학회지

Purpose@#The purpose of this study is to compare five interdental cleansing products' effectiveness on removing artificial dental plaque on the interdental space of zirconia crowns. @*Materials and Methods@#A model with abutments on the right mandibular second premolar and first molar were prepared. 10 zirconia crowns for each abutment were fabricated. After applying artificial dental plaque between the zirconia crowns, a single clinician attempted to remove the plaque with five products: interdental toothbrush, end-tuft toothbrush, dental floss, Easypick, Water pik. They were conducted 10 times per group. The aspect and area of removed surfaces were analyzed using images taken with a digital camera. One factor analysis of variance was performed as a statistical analysis, and a post-hoc test was performed using the Scheffé method (P < .05). @*Results@#There were differences in the area and the pattern according to the characteristics of the products. The largest area, including the marginal portion, was removed in the dental floss group. Interdental toothbrush group was the most effective in removing the dental plaque at the marginal portion. Easypick was less effective than the interdental toothbrush. The end-tuft toothbrush showed better results than other products in cleansing mesiobuccal and distobuccal area, but could not cleanse the area directly below the contact point. In Water pik group, artificial dental plaque was scarcely removed. The removal rate of artificial dental plaque was in the order of floss (69.47%), end-tuft toothbrush (49.36%), interdental toothbrush (44.20%), Easy pick (13.04%), and Water pik (0.59%). @*Conclusion@#Dental floss showed the highest removal rate in the interdental space restored with zirconia crowns, while interdental toothbrush was the most effective in removing the dental plaque at the marginal portion.

Comparison of the effect of removing artificial dental plaque depending on various interdental cleaning products on the interdental surface of zirconia crowns / 대한치과보철학회지

Purpose@#The purpose of this study is to compare five interdental cleansing products' effectiveness on removing artificial dental plaque on the interdental space of zirconia crowns. @*Materials and Methods@#A model with abutments on the right mandibular second premolar and first molar were prepared. 10 zirconia crowns for each abutment were fabricated. After applying artificial dental plaque between the zirconia crowns, a single clinician attempted to remove the plaque with five products: interdental toothbrush, end-tuft toothbrush, dental floss, Easypick, Water pik. They were conducted 10 times per group. The aspect and area of removed surfaces were analyzed using images taken with a digital camera. One factor analysis of variance was performed as a statistical analysis, and a post-hoc test was performed using the Scheffé method (P < .05). @*Results@#There were differences in the area and the pattern according to the characteristics of the products. The largest area, including the marginal portion, was removed in the dental floss group. Interdental toothbrush group was the most effective in removing the dental plaque at the marginal portion. Easypick was less effective than the interdental toothbrush. The end-tuft toothbrush showed better results than other products in cleansing mesiobuccal and distobuccal area, but could not cleanse the area directly below the contact point. In Water pik group, artificial dental plaque was scarcely removed. The removal rate of artificial dental plaque was in the order of floss (69.47%), end-tuft toothbrush (49.36%), interdental toothbrush (44.20%), Easy pick (13.04%), and Water pik (0.59%). @*Conclusion@#Dental floss showed the highest removal rate in the interdental space restored with zirconia crowns, while interdental toothbrush was the most effective in removing the dental plaque at the marginal portion.

Elevated Serum Leptin Receptor and Insulin-like Growth Factor-1 Levels and High Levels of Leptin Receptor Expression in Acanthosis Nigricans Patients: Serologic and Histopathologic Analyses / 대한피부과학회지

Background@#Acanthosis nigricans is characterized by a velvety thickening of the epidermis accompanied by different degrees of hyperpigmentation, and known to be linked to obesity and insulin resistance. @*Objective@#We aimed to analyze obesity-related factors in acanthosis nigricans patients and to evaluate the correlations between acanthosis nigricans and various factors. @*Methods@#From January 2004 to February 2015, 27 acanthosis nigricans patients participated in this study. Blood samples were collected from a control group of seven overweight people and from the seven acanthosis nigricans patients, and they were analyzed for different obesity-related factors. Skin samples were collected from the 23 acanthosis nigricans patients and from 11 patients with epidermal nevi, and immunohistochemistry was performed to detect the presence of adiponectin receptor 1, adiponectin receptor 2, and the leptin receptor. @*Results@#The median serum leptin level in the acanthosis nigricans patients (13 ng/mL) was significantly higher than that in the overweight control individuals (8.9 ng/mL) (p=0.021). The acanthosis nigricans patients had significantly higher levels of insulin-like growth factor-1 in their serum samples (p=0.017). The immunohistochemical analysis determined that the skin from the acanthosis nigricans patients stained significantly more intensely for the leptin receptor compared with that seen in the skin from the patients with epidermal nevi (p=0.002). @*Conclusion@#In conclusion, this study’s findings suggest that the levels of leptin and insulin-like growth factor-1 in the serum, and the expression of the leptin receptor in the skin are elevated with acanthosis nigricans.

Nobiletin attenuates neurotoxic mitochondrial calcium overload through K⁺ influx and ΔΨ(m) across mitochondrial inner membrane

Mitochondrial calcium overload is a crucial event in determining the fate of neuronal cell survival and death, implicated in pathogenesis of neurodegenerative diseases. One of the driving forces of calcium influx into mitochondria is mitochondria membrane potential (ΔΨ(m)). Therefore, pharmacological manipulation of ΔΨ(m) can be a promising strategy to prevent neuronal cell death against brain insults. Based on these issues, we investigated here whether nobiletin, a Citrus polymethoxylated flavone, prevents neurotoxic neuronal calcium overload and cell death via regulating basal ΔΨ(m) against neuronal insult in primary cortical neurons and pure brain mitochondria isolated from rat cortices. Results demonstrated that nobiletin treatment significantly increased cell viability against glutamate toxicity (100 µM, 20 min) in primary cortical neurons. Real-time imaging-based fluorometry data reveal that nobiletin evokes partial mitochondrial depolarization in these neurons. Nobiletin markedly attenuated mitochondrial calcium overload and reactive oxygen species (ROS) generation in glutamate (100 µM)-stimulated cortical neurons and isolated pure mitochondria exposed to high concentration of Ca²⁺ (5 µM). Nobiletin-induced partial mitochondrial depolarization in intact neurons was confirmed in isolated brain mitochondria using a fluorescence microplate reader. Nobiletin effects on basal ΔΨ(m) were completely abolished in K⁺-free medium on pure isolated mitochondria. Taken together, results demonstrate that K⁺ influx into mitochondria is critically involved in partial mitochondrial depolarization-related neuroprotective effect of nobiletin. Nobiletin-induced mitochondrial K⁺ influx is probably mediated, at least in part, by activation of mitochondrial K⁺ channels. However, further detailed studies should be conducted to determine exact molecular targets of nobiletin in mitochondria.

Canine adipose tissue-derived mesenchymal stem cells ameliorate severe acute pancreatitis by regulating T cells in rats

Severe acute pancreatitis (SAP) is associated with systemic complications and high mortality rate in dogs. Mesenchymal stem cells (MSCs) have been investigated for their therapeutic potential in several inflammation models. In the present study, the effects of canine adipose tissue-derived (cAT)-MSCs in a rat model of SAP induced by retrograde injection of 3% sodium taurocholate solution into the pancreatic duct were investigated. cAT-MSCs labeled with dioctadecyl-3,3,3′-tetramethylindo-carbocyanine perchlorate (1 × 10⁷ cells/kg) were systemically administered to rats and pancreatic tissue was collected three days later for histopathological, quantitative real-time polymerase chain reaction, and immunocytochemical analyses. Greater numbers of infused cAT-MSCs were detected in the pancreas of SAP relative to sham-operated rats. cAT-MSC infusion reduced pancreatic edema, inflammatory cell infiltration, and acinar cell necrosis, and decreased pancreatic expression of the pro-inflammatory cytokines tumor necrosis factor-α, interleukin (IL)-1β, -6, -12, -17, and -23 and interferon-γ, while stimulating expression of the anti-inflammatory cytokines IL-4 and IL-10 in SAP rats. Moreover, cAT-MSCs decreased the number of clusters of differentiation 3-positive T cells and increased that of forkhead box P3-positive T cells in the injured pancreas. These results indicate that cAT-MSCs can be effective as a cell-based therapeutic strategy for treatment of SAP in dogs.

Corrigendum: Effects of Toll-like receptor antagonist 4,5-dihydro-3-phenyl-5-isoxasole acetic acid on the progression of kidney disease in mice on a high-fat diet Volume 33, Issue 1, March 2014, Pages 33-44

The authors apologize for a wrong unit in the table 1.

Effects of Toll-like receptor antagonist 4,5-dihydro-3-phenyl-5-isoxasole acetic acid on the progression of kidney disease in mice on a high-fat diet

BACKGROUND: Obesity-related metabolic disorders are closely associated with inflammation induced by innate immunity. Toll-like receptors (TLRs) play a pivotal role in the innate immune system by activating proinflammatory signaling pathways. GIT27 (4,5-dihydro-3-phenyl-5-isoxasole acetic acid) is an active immunomodulatory agent that primarily targets macrophages and inhibits secretion of tumor necrosis factor alpha [as well as interleukin (IL)-1beta, IL-10, and interferon gamma]. However, the effect of TLR antagonist on kidney diseases has rarely been reported. We investigated whether the TLR antagonist GIT27 has beneficial effects on the progression of kidney disease in obese mice on a high-fat diet (HFD). METHODS: Six-week-old male C57BL/6 mice were divided into three groups: mice fed with normal chow diet (N=4); mice fed with a HFD (60% of total calories from fat, 5.5% from soybean oil, and 54.5% from lard, N=4); and GIT27-treated mice fed with a HFD (N=7). RESULTS: Glucose intolerance, oxidative stress, and lipid abnormalities in HFD mice were improved by GIT27 treatment. In addition, GIT27 treatment decreased the urinary excretion of albumin and protein in obesity-related kidney disease, urinary oxidative stress markers, and inflammatory cytokine levels. This treatment inhibited the expression of proinflammatory cytokines in the kidneys and adipose tissue, and improved extracellular matrix expansion and tubulointerstitial fibrosis in obesity-related kidney disease. CONCLUSION: TLR inhibition by administering GIT27 improved metabolic parameters. GIT27 ameliorates abnormalities of lipid metabolism and may have renoprotective effects on obesity-related kidney disease through its anti-inflammatory properties.

Prediction of infarct severity from triiodothyronine levels in patients with ST-elevation myocardial infarction

BACKGROUND/AIMS: The aim of the present study was to evaluate the relationship between thyroid hormone levels and infarct severity in patients with ST-elevation myocardial infarction (STEMI). METHODS: We retrospectively reviewed thyroid hormone levels, infarct severity, and the extent of transmurality in 40 STEMI patients evaluated via contrast-enhanced cardiac magnetic resonance imaging. RESULTS: The high triiodothyronine (T3) group (> or = 68.3 ng/dL) exhibited a significantly higher extent of transmural involvement (late transmural enhancement > 75% after administration of gadolinium contrast agent) than did the low T3 group (60% vs. 15%; p = 0.003). However, no significant difference was evident between the high- and low-thyroid-stimulating hormone/free thyroxine (FT4) groups. When the T3 cutoff level was set to 68.3 ng/dL using a receiver operating characteristic curve, the sensitivity was 80% and the specificity 68% in terms of differentiating between those with and without transmural involvement. Upon logistic regression analysis, high T3 level was an independent predictor of transmural involvement after adjustment for the presence of diabetes mellitus (DM) and the use of glycoprotein IIb/IIIa inhibitors (odds ratio, 40.62; 95% confidence interval, 3.29 to 502; p = 0.004). CONCLUSIONS: The T3 level predicted transmural involvement that was independent of glycoprotein IIb/IIIa inhibitor use and DM positivity.

Use of laparoscopy for diagnosing experimentally induced acute pancreatitis in dogs

Diagnosis of acute pancreatitis in dogs remains a significant challenge despite the development of advanced diagnostic methodologies. Visual inspection and pancreas biopsy using laparoscopy are generally considered to be procedures free of complications when conducted on healthy animals. However, the usefulness of laparoscopy for diagnosing acute pancreatitis has not been assessed. In the present study, the efficacy of laparoscopy for diagnosing acute pancreatitis in dogs was evaluated in animals with experimentally induced acute pancreatitis. Gross appearance of the pancreatic area was examined by laparoscopy to survey for the presence of edema, adhesions, effusion, pseudocysts, hemorrhage, and fat necrosis. Laparoscopic biopsy was performed and the histopathologic results were compared to those of pancreatic samples obtained during necropsy. The correlation between laparoscopy and histopathologic findings of the pancreas was evaluated. The presence of adhesions, effusion, and hemorrhage in the pancreatic area observed by laparoscopy significantly correlated with the histopathologic results (p < 0.05). There was no significant relationship between the histopathologic and laparoscopic biopsy findings. Results of this study suggested that laparoscopic evaluation of gross lesions has clinical significance although the laparoscopic biopsy technique has some limitations. This method combined with additional diagnostic tools can be effective for diagnosing acute pancreatitis in dogs.

Association Between Work Conditions and Smoking in South Korea

BACKGROUND: A variety of sociodemographic factors, such as gender, age, household income, and educational level, influence individuals' likelihood of smoking. Work-related factors may also be linked to smoking behavior. We sought to investigate the relationship between smoking and work environment in South Korea. METHODS: We analyzed data from the Fifth Korean National Health and Nutrition Examination Survey to determine whether there was an association between smoking and occupation type (e.g., manual, nonmanual, or service work), night-shift work, and hours worked/week (e.g., 60 hours) for 4,685 workers. Regression models were adjusted for sociodemographic variables such as age, recent alcohol consumption, hours slept, educational level, and household income. RESULTS: The prevalence of smoking was 50.1% in men and 7.2% in women. For women, manual workers had 2.34 times [95% confidence interval (CI): 1.02-5.36] greater odds of smoking compared with nonmanual workers, whereas service workers had 2.37 times greater odds (95% CI: 1.28-4.40). Furthermore, women who worked 49-60 hours had 2.21 times greater odds of smoking (95% CI: 1.10-3.75) as compared with women who worked 40-48 hours. CONCLUSION: Women who work long hours or who are employed in service or manual positions are more likely to smoke. These results indicate a need in South Korea to target these specific groups when creating nonsmoking policies.

Comparison of laboratory characteristics between acute promyelocytic leukemia and other subtypes of acute myeloid leukemia with disseminated intravascular coagulation

BACKGROUND: Acute promyelocytic leukemia (APL) is an acute myeloid leukemia (AML) subtype with distinctive cell morphology, molecular presentation, clinical course, and treatment. About 90% of APL patients present with hemorrhagic complications due to disseminated intravascular coagulation (DIC). When APL is suspected, all-trans retinoic acid (ATRA) treatment is recommended even before confirmation by molecular tests. Specific criteria for differentiating unconfirmed APL from other AML subtypes with DIC are currently lacking. We aimed to achieve the early diagnosis of APL from other AML types with DIC by restricting the DIC criteria. METHODS: We retrospectively analyzed 29 patients newly diagnosed with AML accompanied by DIC from January 2005 to January 2013. RESULTS: Fibrin degradation products (FDP) (77.7 microg/mL vs. 23.7 microg/mL, p=0.026), D-dimer (7,376.2 ng/mL vs. 1,315.2 ng/mL, p=0.018), and TIBC (264.4 microg/dL vs. 206.8 microg/dL, P=0.046) were higher, while fibrinogen (133.8 mg/dL vs. 373.2 mg/dL, p or =27 microg/mL, D-dimer > or =2,071 ng/mL, and fibrinogen < or =279 mg/dL were our threshold values. These markers may be characteristic to APL and helpful in presumptive diagnosis. CONCLUSION: APL may be differentiated from other AML subtypes by core markers of DIC (FDP, D-dimer, and fibrinogen). We suggest that clinicians set new diagnostic thresholds by restricting the DIC criteria. These findings support the early initiation of ATRA, prior to confirmation by PML-RARA molecular testing.

Correlates of the Severity of Coronary Atherosclerosis in Long-term Kidney Transplant Patients

Coronary artery disease remains the leading cause of early death and graft loss in renal transplant patients. The aim of this study was to identify clinical and echocardiographic parameters independently associated with the angiographically-determined severity of coronary atherosclerosis in long-term kidney transplant patients. Fifty-two kidney transplant recipients who underwent elective coronary angiography were reviewed retrospectively. Angiographic severity was evaluated using the modified Gensini index (MGI). The mean age at coronary angiography was 52.5+/-7.9 yr with a mean prior transplant duration of 118.1+/-58.8 months. Pearson correlation analysis demonstrated a positive correlation of MGI with transplant duration before coronary angiography and chronic allograft nephropathy, whereas an inverse correlation was demonstrated with ejection fraction and statin use. On subsequent multivariate linear regression analysis, transplant duration before coronary angiography, statin use, and ejection fraction were independently associated with the severity of coronary atherosclerosis in long-term kidney transplant patients. In summary, our study demonstrates that statin use, ejection fraction, and transplant duration before coronary angiography are independent parameters associated with the severity of coronary atherosclerosis in long-term kidney transplant patients. Further investigation is required to reduce the atherosclerotic burden in kidney transplant patients.

A suspected case of Lyme borreliosis in a hunting dog in Korea

A two-year-old male Pointer had been presented with anorexia, cachexia, and weight loss of 10-day duration. Upon physical examination, fever, lethargy, superficial lymph node enlargement, and tick infestation were noted. The only abnormality in CBC and serum chemistry analyses was mild hyperglobulinemia. Spleen was enlarged by radiography, and the lymph nodes showed neutrophilic lymphadenitis by cytological examination. A polymerase chain reaction test for babesiosis and commercial ELISA tests for Ehrlichia canis, heartworm, and Lyme disease was negative except for Lyme disease, which was verified by both an IFA-IgG test and a quantitative C6 assay. Doxycycline was administered for 2 weeks and the recovery was uneventful. Post-treatment C6 titer decreased to within normal limits.

The High-Voltage Electron Microscopy in Biomedical Research / 대한해부학회지

Transmission electron microscopy (TEM) provides high resolution images, which are useful in studying ultrastructure of cells and tissues. We have to use very thin section about 60~100 nm thickness due to poor penetration power of the conventional TEM at 100 kV. To overcome this limitation, TEMs using higher accelerating voltage have been developed. TEMs can be categorized into conventional TEM, intermediate TEM, high voltage TEM (HVEM), and ultrahigh voltage TEM according to their accelerating voltage. HVEM using 500~1,000 kV has an enough penetration power to observe thick specimen up to 3~4 micro, which is useful understanding 3 dimensional configuration of the cell and tissue. HVEM was built up in Korea Basic Science Institute (KBSI, Daejeon, Korea) at 2004, maximum accelerating voltage is 1.3 MV in Korea. Many results showed up to the present various fields of science such as medical science, biology, agriculture and so on. Here, we briefly summarize recent biomedical applications of HVEM to provide an insight of HVEM for morphologist.

The Effect of Uric Acid on GFR in Early Period after Kidney Transplantation / 대한신장학회지

PURPOSE: Hyperuricemia is a common complication occurring shortly after kidney transplantation. Although increased uric acid level is a risk factor for cardiovascular disease and mortality, the relationship between uric acid level and graft function after transplantation has been a controversial issue. Therefore, we investigated the effects of uric acid on glomerular filtration rate (GFR) and graft survival in the early periods of kidney transplantation. METHODS: Data were collected from 245 patients who underwent kidney transplantation between 2002 and 2004 at Yonsei University Medical Center. Uric acid level and estimated GFR were measured monthly during the first 6 months and then yearly for 3 years. RESULTS: The mean age of the study population was 40.2+/-11.7 years. The proportion of patients with hyperuricemia (uric acid < or =6.8 mg/dL) showed increment during the 3 year follow up. Increased serum uric acid level showed a negative correlation with estimated GFR during the initial 6 months after transplantation (r=-0.026, p<0.05). In Kaplan-Meier analysis, patients with a mean uric acid level higher than 6.8 mg/dL during the first 6 months showed a lower cumulative graft survival during the consecutive 3 years compared to patients with a uric acid level lower than 6.8 mg/dL (HR 1.7, p=0.003). CONCLUSION: Uric acid levels were associated with the changes of GFR in the initial 6 months of kidney transplantation, and the hyperuricemia during the early stages of transplantation might influence the long term graft survival.

A comparison study between mycophenolate mofetil and cyclophosphamide for treatment of proliferative lupus nephritis / 대한내과학회지

BACKGROUND/AIMS: Our study aimed to evaluate the efficacy of MMF as compared with intravenous cyclophosphamide as induction therapy for proliferative lupus nephritis in Koreans. METHODS: Forty-three patients who were diagnosed with proliferative lupus nephritis (WHO Class III and IV) between Jan 2000 and Dec 2006 were included in this study. Nineteen patients were treated with oral MMF (initial dose: 1.0 g/day and then it was increased to 2.0 g/day) and 24 patients were treated with 0.75-1.0 g/m2 of monthly intravenous cyclophosphamide (CP) followed by subsequent treatment with oral corticosteroid (initial dose 1 mg/kg/day and then it was slowly tapered down) for 6 months. The demographic and laboratory findings, the response rate and the adverse events were reviewed retrospectively and these were compared between the two groups. RESULTS: A complete response occurred in 7 out of the 19 patients (36.8%) treated with MMF and in 8 out of the 24 patients (33.3%) treated with CP, and the difference was not significantly different between the two groups (p=0.66). A partial response was achieved in 52.6% and 45.8%, respectively. There were no significant differences of the laboratory findings such as serum albumin, C3, C4, the urine protein/creatinine ratio and serum creatinine after treatment for 6 months. In addition, both groups had similar rates of adverse events. CONCLUSIONS: Our study showed that for the treatment of lupus nephritis, MMF was as effective as IV cyclophosphamide with similar adverse events. This finding suggests that MMF could be an alternative treatment for active lupus nephritis as induction therapy.

Comparison of Various Methods for Estimating Glomerular Filtration Rate in Patients with Chronic Kidney Disease / 대한신장학회지

PURPOSE: Several methods are used to estimate glomerular filtration rate (GFR), but there are limitations in each method. We investigated the variation in GFR measured by different methods in patients with chronic kidney disease (CKD). METHODS: 549 patients with CKD stages 2-5, who underwent creatinine clearance (Ccr) and (99m)Tc-DTPA renal scan, were enrolled. GFR was calculated by using Cockcroft-Gault equation (CG-GFR) and MDRD equation (MDRD-GFR). The correlations between MDRD-GFR and GFR estimated by other methods were analyzed according to CKD stages and age groups ( or = 60 years). RESULTS: The mean age of patients was 55+/-19 year (male 60%). CG-GFR, Ccr, and estimated GFR by (99m)Tc-DTPA renal scan (DTPA-GFR) correlated significantly with MDRD-GFR in all CKD stages and all age groups (p<0.01). Compared to patients with stages 2-4 CKD, however, the possibilities of CGGFR, Ccr, and DTPA-GFR to be within 30% of MDRD-GFR were significantly lower in stage 5 CKD patients (p<0.05). In addition, the ratio of DTPA-GFR/MDRD-GFR in stage 5 CKD patients was 2.24+/-1.40, indicating overestimation of DTPA-GFR in these patients. On the other hand, the accuracy of various GFR-estimating methods was higher in patients aged more than 60 years compared to the others. CONCLUSION: CG-GFR, Ccr, and DTPA-GFR correlated significantly with MDRD-GFR, but there was a wide variation in GFR estimated by various methods. Therefore, a careful interpretation of estimation in GFR is needed according to the stage of CKD and the age of patients.

Changes in Skin Color in Hemodialysis Patients According to Dialysis Modality / 대한신장학회지

PURPOSE: Skin hyperpigmentation in end stage renal disease patients is known to be attributed to the accumulation of middle molecular weight (MMW) substances such as urochromic pigments and carotenoids. Therefore, there is a possibility that hyperpigmentation may be improved by high-flux hemodialysis (HF-HD) and online hemodiafiltration (HDF). This prospective study was undertaken to investigate the quantitative changes in skin color in HD patients according to dialysis modality. METHODS: Eighty-two stable ESRD patients undergoing HD were enrolled and divided into three groups according to their dialysis modality. Melanin index and erythema index of forearm and abdomen (nonsun exposed area), and forehead (sun exposed area) were measured by narrow-band reflectance spectrophotometer at baseline and after 12 months. RESULTS: There were no significant differences in the baseline values of melanin and erythema indices among the three groups. But the changes in forehead melanin index were significantly lower in HDF patients (-1.0+/-2.4%) compared to the LF-HD group (0.3+/-1.6%) (p<0.05), and forehead erythema index was significantly decreased in patients treated by HDF (-1.6+/-2.5%) relative to the lowflux hemodialysis group (-0.1+/-2.5%) (p<0.05). CONCLUSION: The changes in skin color of sun exposed area were reduced by HDF, suggesting that enhanced removal of MMW substances by convective therapy may be of advantage to skin hyperpigmentation in ESRD patients.