A Study on the Usefulness of Postmortem Diabetes Mellitus-Related Tests / 대한법의학회지

Diabetes mellitus (DM) is a group of metabolic disorders, that have become a major cause of death worldwide. This study aimed to determine the usefulness of diabetes-related laboratory tests for diagnosis of postmortem DM. From March to August 2018, among the autopsy cases investigated by the National Forensic Service, heart blood and vitreous humor samples from 253 cases that had not been decomposed were collected, and the data from 208 cases except 45 cases that were incapable of testing were analyzed for statistical significance and compared with the causes of death on autopsy reports. The levels of C-peptide, insulin, acetoacetate, β-hydroxybutyrate (β-HA), total ketone, and HbA1c were measured in the heart blood, and the levels of glucose, blood urea nitrogen, creatinine, and potassium were measured in the vitreous humor. The levels of glucose in the vitreous humor and HbA1c, β-HA, and total ketone in the heart blood were significantly correlated. C-peptide and insulin levels were lower than normal levels in most cases (C-peptide 92.3%, P=0.480, insulin 97.6%, P=0.589), and were not useful measures indicating diabetic complications. In the group with DM history, the average levels of HbA1c from the heart blood and glucose from the vitreous humor were higher than in those with no or unknown history of DM, indicating their usefulness as diagnostic tools. The results of this study suggest a postmortem DM diagnosis model.Therefore, postmortem DM-related tests can help diagnose the cause of death in forensic medicine.

Natural soluble human leukocyte antigen class I in donor serum neutralizes donor-specific HLA alloantibodies in recipient serum

Background@#Human leukocyte antigen (HLA) molecules are cell-bound but can be identified in a soluble form. These soluble HLA (sHLA) molecules have an immunomodulatory function. We investigated whether natural sHLA in donor serum can neutralize donor-specific HLA alloantibodies (DSAs) in recipient serum. @*Methods@#Neutralizing effects of donor serum on DSAs in recipient serum were measured using inhibition assay principle of flow cytometric crossmatch (FCXM), performed using sera from 143 kidney transplant recipients and their donors. The adding of donor serum to recipient serum yielded lower mean fluorescence intensity (MFI) ratios (test/control) than when diluent was added [Roswell Park Memorial Institute (RPMI) or third-party serum], which was presumed to be caused by the neutralizing effects of sHLA. @*Results@#In the recipient group with class I DSAs alone (N=14), donor serum addition to recipient serum resulted in lower T cell MFI ratios [2.25 (1.31‒32.51)] than those observed on RPMI addition [3.04 (1.33‒125.39), P ＜0.05]. In the recipient group with class II DSAs alone (N=27), donor serum addition showed no significant difference in B cell MFI ratios [5.03 (1.41‒103.53)] compared to diluent addition: RPMI [4.50 (1.34‒145.98)] or third-party serum [5.08 (1.44‒138.47)], P ＞0.05 for both. @*Conclusion@#Using inhibition FCXM, we verified that natural sHLA class I in donor serum neutralizes DSAs in recipient serum. However, no neutralizing effects of sHLA class II were revealed in this study. These potentially beneficial effects of sHLA infused via blood-derived products should be considered when desensitizing highly HLA-sensitized patients.

Ten Cases of Taenia saginata Infection Confirmed by Analysis of the Internal Transcribed Spacer 1 rDNA Region in the Republic of Korea

From October 2015 to August 2018, tapeworm proglottids were obtained from 10 patients who were residents of Daegu and Gyeongbuk provinces and had a history of raw beef consumption. Most of them had no overseas travel experience. The gravid proglottids obtained from the 10 cases had 15–20 lateral uterine branches. A part of internal transcribed spacer 1 (ITS1) DNA of the 10 cases, amplified by polymerase chain reaction (PCR) and digested with AleI restriction enzyme, produced the same band pattern of Taenia saginata, which differentiated from T. asiatica and T. solium. Sequences of ITS1 and cytochrome c oxidase subunit 1 (cox1) showed higher homology to T. saginata than to T. asiatica and T. solium. Collectively, these 10 cases were identified as T. saginata human infections. As taeniasis is one of the important parasitic diseases in humans, it is necessary to maintain hygienic conditions during livestock farming to avoid public health concerns.

A comparative analysis of patients with mesiodenses: a clinical and radiological study

OBJECTIVES: A mesiodens appears most commonly as a supernumerary tooth impacted in the anterior maxilla. The purpose of this study is analyze mesiodens clinically. MATERIALS AND METHODS: Gender, crown form, direction of impaction, relation to permanent incisors, and chief complaints of patients with extracted mesiodens were analyzed. RESULTS: Patients were analyzed for motivation to visit the hospital; 85.4% of the patients were referred from other hospitals. Mesiodens was more common in males than in females (3.7:1), and 70.1% of patients had only one mesiodens, while 29.6% had two mesiodenses. Of the mesiodenses, 61.4% were of the aconical form, and the most common direction was upward (62.4%), followed by the normal position (26.0%) and the horizontal position (11.6%). The mesiodenses caused orthodontic problems with the permanent incisors in 46.3% of cases. Mesiodens associated with dentigerous cyst was rarely observed in our patient group. CONCLUSION: Mesiodens is more common in males than in females and often affects the permanent incisors. Thus, careful clinical and radiological evaluations of mesiodenses are important.

Clinical Significance of Platelet Count at day +60 After Allogeneic Peripheral Blood Stem Cell Transplantation

Thrombocytopenia (TP) is a frequent complication after allogeneic stem cell transplantation (SCT) and regarded as a poor prognostic factor, especially in patients with chronic graft-versus-host disease (GVHD), although various factors were related to the development of TP after allogeneic SCT. Sixty-three patients receiving allogeneic peripheral blood stem cell transplantation (PBSCT) were stratified according to platelet count (PC) at day +60 and analyzed in terms of overall survival (OS) and the incidence of non-relapse mortality (NRM). Ten patients (15.9%) were stratified in group 1 (PC or =80 x 10(9)/L). Group 3 was associated with lower incidence of extensive chronic GVHD (p=0.013), better 3-yr OS (p=0.0030), and lower NRM rate (p<0.0001). In multivariate analyses, the PC at day +60 was identified as an independent prognostic factor (p=0.003) together with CD34+ cell dose (p<0.001), disease risk (p=0.004), and acute GVHD (p=0.033) in terms of NRM, and the PC (p=0.047) and CD34+ cell dose (p=0.026) in terms of incidence of infectious events. Measuring the platelet count at day +60 is a simple method for predicting the risk of chronic GVHD development and prognosis after allogeneic PBSCT.

FLT3 Gene Mutations as a Prognostic Factor for Acute Myeloid Leukemia / 대한진단검사의학회지

BACKGROUND: Two distinct types of fms-like tyrosine kinase 3 (FLT3) gene mutations have been identified in acute myeloid leukemia (AML): D835 and internal tandem duplication (ITD) mutations. These mutations are known to cause the proliferation of leukemic cells and inhibit the apoptosis of leukemic cells due to ligand-independent activation of their receptors. Therefore, the current study attempted to investigate the frequency of FLT3 gene mutations and their prognostic implications for AML in terms of treatment response, survival, and relapse. METHODS: Polymerase chain reaction (PCR) was performed to detect D835 and ITD mutations in 84 newly diagnosed AML patients from February 2001 to October 2004. Restriction fragment length polymorphism (RFLP) and direct sequencing were performed to analyze the D835 mutations. The results were examined based on a comparison with previously known prognostic factors, and the treatment outcomes analyzed according to the existence of the mutations in relation to the event free survival (EFS), overall survival (OS), and complete remission (CR) rates. RESULTS: D835 and IDT mutations were detected in 4.7% (4/84) and 19.0% (16/84), respectively, of the AML patients. The FLT3 gene mutations were not found to be associated with previously known prognostic factors, such as the WBC count, age, and cytogenetic risk group, but were associated with the lactate dehydrogenase levels. The EFS and OS rates were also significantly lower in the FLT3 gene mutation group, especially in AML with normal karyotypes. CONCLUSIONS: FLT3 gene mutations were observed in 23.8% of AML patients and appeared to have a prognostic implication on patient survival. Accordingly, the presence of FLT3 gene mutations, which could be tested easily by using PCR/RFLP methods, should be investigated routinely at the time of diagnosis.

TT Virus (TTV) Infection in General Population, Chronic Liver Diseases, Hemodialysis, and Transfused Patients / 대한임상미생물학회지

BACKGROUND: TT virus (TTV), isolated initially from a Japanese patient with posttransfusion hepatitis of unknown etiology, was suggested to be a new causative agent of hepatitis. However, it has been found to infect both healthy and diseased individuals and numerous studies have raised questions about its pathogenic role in hepatitis. In order to study its prevalence and clinical impact on hepatitis, we assessed the frequency of TTV DNA. METHODS: Serum samples were obtained from 60 cases of the controls, 77 cases of chronic liver diseases, 44 cases of hemodialyzed patients, and 65 cases of transfused patients. TTV DNA was detected using nested polymerase chain reaction and alanine aminotransferase (ALT), aspartate aminotransferase (AST), and hepatitis B surface antigen (HBsAg) were measured. RESULTS: TTV DNA was detected in 41.7% of the controls, 51.9% of patients with chronic liver diseases, 68.2% of hemodialyzed patients and 61.5% of transfused patients. Comparison between patients with or without TTV revealed no significant differences in AST, ALT, and HBsAg test results. CONCLUSION: The prevalance of TTV infection in patients with chronic liver diseases was similar to that in the controls. TTV infection was not related to abnormal liver function findings and HBsAg positivity. We found no relationship between TTV infection and chronic liver diseases.

Electrophysiological Abnormalities in a Patient with Acute Methyl Bromide Poisoning

No abstract available.

Estimate of Thrombopoiesis by Flow Cytometric Analysis of Reticulated Platelets in Patients with Severe Thrombocytopenia / 대한진단검사의학회지

BACKGROUND: Analysis of reticulated platelets (RPs) is useful for discriminating the causes of thrombocytopenia and monitoring the thrombopoiesis. In the patients with severe thrombocytopenia, we evaluated the thrombopoiesis-discriminating ability of several indices applying forward scatter (FSC) and thiazole orange (TO) fluorescence in addition to the percentage of reticulated platelets (RPs%). METHODS: Forty cases with decreased thrombopoiesis, twenty cases with increased thrombopoiesis and twenty cases with liver cirrhosis were selected. By flow cytometry with two analytic methods, dependent on or independent of the staining of CD41-PE as a platelet marker, the primary parameters including RPs% were measured and the applied parameters were calculated from them. And we compared the diagnostic efficiency of each parameter and analyzed the purity of platelet light scatter gate. RESULTS: The purity of platelet light scatter gate was significantly lower in patients with severe thrombocytopenia than in healthy persons with normal platelet counts (P<10(-6)), so the use of CD41-PE for platelet gating improved the diagnostic efficiency of RPs%. Compared to the primary parameters, the applied parameters originated from RPs%, FSC and TO fluorescence improved diagnostic efficiency significantly (RPs%: 55%, RPs%xs delta MFI: 80%) between decreased and increased thrombopoiesis groups. CONCLUSIONS: In the patients with severe thrombocytopenia, the estimate of the thrombopoiesis by a flow cytometric analysis can be more predictable by using platelet markers and by considering the fluorescence intensity of TO together with the RPs%.

Comparative Study for the Determination of HER2 gene Amplification and Overexpression in Breast Cancer

PURPOSE: The human epidermal growth factor receptor-2 (HER2) is overexpressed in breast cancer. The subset of patients with breast cancer demonstrating a HER2-positive status has aggressive tumors and a poor prognosis. Knowledge of the HER2 status is prerequisite when considering a patient's eligibility for anti-HER2 targeted therapy (Herceptin(R)). There are several assays available for determining the HER2 status. The aim of this study was to compare and evaluate the HER2 status in breast cancer by means of immunohistochemistry (IHC), FISH and real-time PCR. METHODS: DNA samples from fresh tumor tissues of 20 patients with breast cancer were analyzed with real-time PCR, using the LightCycler-HER2/neu PCR assay. A tissue microarray, containing 20 samples obtained from formalin- fixed, paraffin-embedded tissues, was used for IHC and FISH (PathyVysionTM). RESULTS: The frequencies of HER2 gene amplification for real-time PCR and FISH were 35 and 65% respectively, and the IHC frequency of overexpression was 70%. This study showed 75% concordance between IHC vs. FISH, 65% between IHC vs real-time PCR and 70% between FISH vs. real-time PCR. Considering real-time PCR as the gold standard, this study showed sensitivities and specificities of 100 and 46.2% for IHC, and of 100% and 53.8% for FISH. CONCLUSION: These results demonstrated marked discordance for the HER2 stati according to the various methods used. IHC, a familiar cost-effective test, will undoubtedly remain in routine clinical practice for HER2 screening but confirmatory HER2 testing using either FISH or real-time PCR is recommended for indeterminate cases. Real-time quantitative PCR for HER2 appears to be clinically useful due to its simplicity and ability to produce rapid results.

Association of Myocardial Infarction and Chlamydophila pneumoniae Infection / 대한임상미생물학회지

BACKGROUND: Although there are growing evidences linking Chlamydophila pneumoniae infection to myocardial infarction, it remains controversial. The authors intended to assess whether C. pneumoniae infection is associated with myocardial infarction. METHODS: Sera and peripheral mononuclear cells (PMNCs) were collected from 54 cases of acute myocardial infarction (MI), 33 cases of old MI, and 60 normal controls. Anti-C.pneumoniae IgG and IgM antibodies were measured using a microimmunofluorescence (mIF) method, and C.pneumoniae DNA was detected using polymerase chain reaction (PCR). RESULTS: Seropositivity of anti-C.pneumoniae IgM antibody by mIF was shown 5.0% in control group, 29.6% (OR=8.00) in the acute MI and 6.1% (OR=1.23) in old MI group. Seropositivity of anti C.pneumoniae IgG antibody were 60.0 % in control group, 92.6% (OR=8.33) in the acute MI and 87.9% (OR= 4.83) in old MI group. The antibody titers in the acute MI and old MI group tended to be higher compared to those in control group. No C.pneumoniae DNA was detected in any case by PCR. CONCLUSION: The seropositivity and antibody titers were significantly higher in the acute MI and old MI group than in control group, suggesting that C.pneumoniae infection may be a risk factor for myocardial infarction.

A Case of Pichia anomala Detected Incidentally in Peripheral Blood Smear / 대한임상미생물학회지

Nosocomial opportunistic infections including fungal infections continue to increase with a longer survival of immunocompromised patients. Disseminated candidiasis is the most common nosocomial fungal infection and the frequency of isolation of non-Candida albicans organisms besides C.albicans is increasing as causative organisms. We detected numerous yeast cells incidentally in a peripheral blood smear of an infant with congenital heart disease who was treated with total parenteral nutrition and catheterization, and had a history of antibiotics use during a long hospitalization period. Pichia anomala was isolated from the blood and pleural effusion.

Variable Number of Tandem Repeats (VNTR) Disparity between Donor and Recipient has a Potential to Predict the Outcomes of HLA-identical Allogeneic Stem Cell Transplantation

BACKGROUND: Detection of variable number of tandem repeats (VNTR) between recipient and donor has been adopted to monitor the degree of chimerism after allogeneic stem cell transplantation (SCT). In allogeneic SCT, besides MHC-disparity, the disparity of various polymorphous proteins encoded by several genes may play a critical role in the pathogenesis of graft-versus-host disease (GVHD). However, the biologic effect of VNTR disparity has been scarcely studied. METHODS: We analyzed 84 patients receiving SCT from HLA-identical sibling (n=68) or unrelated donors (n=16). Enrolled diseases included AML 48, ALL 8, CML 15, NHL 10, and high-risk MDS 3. The PCR was performed to amplify 3 VNTR regions (D1S80, D1S111, and D17S5). RESULTS: We observed strong correlation between the D1S80 disparity and transplant outcomes in terms of OS (P=0.0179) or non-relapse mortality (NRM) (P=0.0305), but not for D1S111 or D17S5 disparity. The D1S80-fully matched pair showed a better OS (72% vs 38%) and lower NRM (17% vs 50%) compared to partially matched or mismatched pairs. In multivariate analyses, D1S80-fully matched pair was found to be independent favorable prognostic factor for OS (P=0.03) or NRM (P=0.05). In addition, the D1S80 disparity was significantly associated with the myeloid engraftment speed (P=0.01) or the occurrence of gut chronic GVHD (P=0.05). CONCLUSION: Our data suggest that disparities in D1S80-located on chromosome1-seemed to be associated with increased incidence of gut chronic GVHD and NRMs, thus suggesting the existence of unknown genes of minor histocompatibility antigens targeting gut or cytokine/cytokine receptor on chromosome 1.

Clinical Significance of HER2/neu Gene Quantification and MAGE assay in Primary Breast Cancer / 대한진단검사의학회지

BACKGROUND: Many studies have reported that the HER2/neu gene and melanoma antigen gene (MAGE) are correlated with the progression and the prognosis of primary breast cancer (PBC). Since anti-HER2/neu monoclonal antibodies were introduced for an adjuvant treatment for PBC, the needs for the assessment of the HER2/neu status have been increased. Accordingly, we compared two methods evaluating HER2/neu status, and performed MAGE assay simultaneously. In addition, we also investigated the association of HER2/neu and MAGE with known disease parameters, and their clinical significance in PBC patients. METHODS: In 50 patients with PBC, HER2/neu protein and HER2/neu gene expression were assessed by immunohistochemical stain (IHC) and real-time quantitative polymerase chain reaction (Rt- Q-PCR), while MAGE expression was assessed by reverse transcriptase (RT)-nested PCR. RESULTS: The HER2/neu protein overexpression and overamplification were noted in 68.0% (34/50) and in 68.1% (32/47) of the patients, respectively. The concordance rate between these two methods was 61.7% (29/47) and the kappa value by analysis of reproducibility was as low as 0.086. HER2/neu protein overexpression was significantly correlated with P53 expression. HER2/neu overamplification was significantly correlated with histologic grades and inversely correlated with estrogen receptor (ER) expression (P=0.033). MAGE was expressed in 46.9% (23/49) in the current study. MAGE expression was shown to be significantly correlated with HER2/neu gene amplification (P=0.002), histological grades and P53 expression, and inversely correlated with ER expression (P=0.014). CONCLUSIONS: The current study revealed that the concordance between IHC and Rt-Q-PCR for HER2/neu evaluation was low in PBC. MAGE expression was significantly correlated with HER2/neu gene amplification and also associated with some clinical prognostic factors. So it is considered that MAGE expression has more important clinical prognostic significance than HER2/neu expression.

Detection of Chlamydophila pneumoniae in Acute Myocardial Infarction / 대한임상미생물학회지

BACKGROUND: There is growing evidence linking infection with Chlamydophila pneumoniae with vascular diseases, such as atherosclerosis and myocardial infarction. However, the data remain inconclusive and the clinical importance of C. pneumoniae as vasculopathic is unclear. So, we intend to detect C. pneumoniae in acute myocardial infarction patients by microimmunofluorescence (mIF) and polymerase chain reaction (PCR). METHODS: Blood and peripheral mononuclear cells (PMNCs) of 24 myocardial infarction patients and 100 normal controls were collected. Serum were used in mIF and PMNCs in PCR. PMNC sample were tested for C. pneumoniae by 'touchdown 'nested PCR. The first round PCR amplified DNA from both C. pneumoniae and Chlamydophila psittaci, while the second round specially targeted C. pneumoniae allowing the two species to be differentiated. RESULTS: Seropositivity of IgG and IgM anti-Chlamydophila pneumoniae antibody titers were 95.8% and 25% in myocardial infarction patients and 61% and 16% in control group, respectively. Positive rates of PCR of PMNCs were 8.3% in the patients and 15% in control group. CONCLUSION: The results of mIF show that mIF positive rate in myocardial infarction was much higher than control group. So an association between C. pneumoniae and myocardial infarction can be concluded. But the opposite results of PCR of PMNCs needed further studies.

Effects of Estrogen Receptor Polymorphisms on Bone Markers and Serum Lipid Levels / 대한진단검사의학회지

BACKGROUND: In post-menopausal women, osteoporosis and cardiovascular diseases which are partly due to estrogen deficiency, occur more common than in pre-menopause women. Estrogen action is supposed to be mediated by an estrogen receptor (ER) and two polymorphisms of the ER gene in particular, Pvu II and Xba I, have been described for several years for genetic association studies. Authors have investigated the frequencies and patterns of the ER gene polymorphisms and their association with bone markers and lipid levels. METHODS: For 121 women who visited the health promotion center of Kyungpook National University Hospital, the ER gene polymorphisms were determined by the Pvu II and Xba I restriction enzymes following polymerase chain reaction. RESULTS: The distributions of ER Pvu II and Xba I restriction fragment length polymorphisms were as follows: PP 15.7%, Pp 47.9%, pp 36.4% and XX 5.8%, Xx 31.4%, xx 62.8%, respectively. And in a combination of two polymorphisms, ppxx was the most common, followed by PpXx, Ppxx, PPXx, PPXX and PPxx in that order. No significant genotypic differences were found in bone mineral density, bone markers and menopausal status. LDL cholesterol and triglyceride levels were significantly different by genotypes in premenopausal women (P<0.05). CONCLUSIONS: The results suggest that ER polymorphisms might be associated with LDL cholesterol and triglyceride levels. Further evaluation in a larger population would be helpful to determine the effects of ER polymorphisms on lipid metabolism and therapeutic trial for cardiovascular diseases in women.

Relation among the Tests and Comparison of Positivity of Tests for Multi-Drug Resistance in Newly Diagnosed Acute Leukemia / 대한진단검사의학회지

BACKGROUND: The expression of multi-drug resistance (MDR) in acute leukemia was known to decrease the outcome of chemotherapy and to increase the rate of relapse. Of the mechanism of MDR, the most well known is P-glycoprotein (P-gp) encoded by the mdr1 gene. There are MDR genes, P-gp tests and drug efflux function tests for the clinical measurement of MDR. To assess the clinical usefulness and MDR expression status in acute leukemia, MDR tests were performed. METHODS: MDR expression was assessed by MDR1 mRNA RT-PCR and flow cytometry measuring P-gp and daunorubicin (DNR) efflux in 77 patients with newly diagnosed acute leukemia (AL) including 48 acute myeloid leukemia (AML), 16 acute lymphoblastic leukemia (ALL) and 13 acute mixed-lineage leukemia (AMLL). The CD34 surface-marker study was also done by flow cytometry. The result of chemotherapy was evaluated by the percentage of remnant bone marrow (BM) blasts. RESULTS: The positivity of MDR1 mRNA was 57.1% (44/77) in AL, 61.5% (8/13) in AMLL, 60.4% (29/48) in AML, and 43.8% (7/16) in ALL. The positivity of P-gp expression was 36.5% (27/74) in AL and 100% in AML. The positivity of the DNR efflux test was 30.1% (22/73) in AL, 40.0% (18/45) in AML, 23.1% (3/13) in AMLL, and 6.7% (1/15) in ALL. There was a significant correlation between MDR1 mRNA and P-gp expression and between MDR1 mRNA and CD34 expression in AML. There was a significant correlation between the percentages of residual blast cells in BM and P-gp expression (P=0.039, r=0.312). CONCLUSIONS: It can be clinically useful to perform the mdr1 gene and P-gp test simultaneously both in newly diagnosed acute leukemia patients. The effectiveness of tests for MDR can be helpful to predict the outcome of chemotherapy.

Immunosenescence-related Markers of T Cell Subsets in Conventional Lymphocyte Immunophenotyping / 대한진단검사의학회지

BACKGROUND: Changes in the T cells are of the main causes of immunosenescence. We searched for the practical markers for immunosenescence with the antibodies used in conventional lymphocyte immunophenotyping. METHODS: Between a young healthy group (mean age 31.2+/-2.9 years) and an old patient group (mean age 83.1+/-3.8 years), CD4lo, CD4-CD8- double negative (DN) and CD4+CD8+ double positive (DP) T cells by three-color flow cytometry were compared. The methods for measurement of DN and DP T cells were evaluated. RESULTS: The markers that differed significantly in the 2 groups were the percentage of DN T cells, DP T cells, and the absolute number of DN T cells and CD4 mean fluorescence intensity. The difference in the absolute number of DN T cells was most significant. The percentages of calculated DN (cDN) T cells and measured DN T cells showed a good correlation (r=0.921, P<10(-26)) in general but had lower correlation in the old age group. Two-color and three-color methods for DP T cells showed good correlation (r=0.916, P<10(-19)). Among the adult disease groups, cDN T cells were significantly low only in the old age group regardless of diseases (P<0.01). CONCLUSIONS: In conventional T cell immunophenotyping in the old age group with diseases, some markers that seemed to be related to immunosenescence could be found. Additional further studies in healthy old age groups will be able to discriminate the relationship of theses markers to disease, age or immunosenescence. The significance of the decrease of DN T cells in immunosenescence needs to be elucidated.

Clinical Utility of Reticulocyte Parameters in the Early Detection of Hematopoietic Engraftment After Stem Cell Transplantation / 대한진단검사의학회지

BACKGROUND: Allogeneic or autologous bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) has been settled a modality of treatment in hematologic malignantdisorders or solid tumors. Because engraftment or not was important for the direction of treatment and prognosis of the patients, various methods, judging it early were groped. Instead of an absoluteneutrophil count (ANC) or platelet count in PB, we used reticulocyte parameters as early predictors of hematopoietic engraftment. METHODS: We measured the ANC with reticulocyte parameters daily in 25 patients receiving allogeneic BMT or PBSCT (n=17, 30.82+/-9.97 years old) and autologous PBSCT (n=8, 30.63+/-8.55 years old) from January 2002 to February 2003 in Kyungpook National University Hospital. Wedefined erythroid engraftment as the first day of a mean corpuscular volume of reticulocyte (MCVr)>or=105 fL and immature reticulocyte fraction (IRF) >or=10% in the second rising peak and myeloid engraftment as the first day of ANC >or=500/microL. RESULTS: The erythroid engraftment occurred after a mean time of 16.24+/-4.16 days in allogeneic graft and 14.00+/-3.55 days in autologous graft and the myeloid engraftment occurred 17.94+/-3.23 days and 15.00+/-2.78 days, respectively. In the allogeneic graft, the erythroid engraftment occurred earlier than the myeloid engraftment (P=0.03). In the autologous graft, the erythroid engraftment preceded the myeloid engraftment; however, it was not statistically significant (P=0.47). Among 3 cases, wherein the erythroid engraftment occurred later than the myeloid engraftment in allogeneic graft, 2cases were ABO-incompatible PBSCT. CONCLUSIONS: Considering that the successive increase of immature reticulocytes preceded that of ANC in most cases, we concluded that as an early indicator of hematopoietic engraftment, reticulocyte parameters such as IRF and MCVr were useful especially observing them simultaneously.

The Efficacy and Safety of Large Volume Leukapheresis in Allogeneic Peripheral Blood Stem Cells Collection / 대한수혈학회지

BACKGROUND: Transplantation of allogeneic peripheral blood stem cells (PBSCs) may have advantage over bone marrow transplantation with regards to the speed of hematopoietic and immunologic recovery. Recently to overcome the need for multiple leukaphereses to collect enough PBSCs for autologous transplantation, large volume leukaphereses (LVL) are used to process multiple blood volumes per session. Experience with this technique in healthy individuals after mobilization with colony stimulating factor (CSF) is limited. We have investigated the efficacy and safety of LVL for the collection of G-CSF and GM-CSF mobilized PBSCs from healthy donors. METHODS: This study was done on 40 healthy donors who were mobilized with G-CSF and GM-CSF for allogeneic peripheral blood stem cells transplantation (allo-PBSCT). After 5 days of mobilization treatment, PBSCs were collected by LVL with Fenwal CS-3000 Plus (Baxter Co, USA). In LVL, heparin was administered in addition to ACD-A. Patients underwent of LVL procedures daily to obtain a target cell dose of >or= 4x10(8)/kg MNCs and >or= 6x10(6)/kg CD34+ cells. RESULTS: 66 LVL procedures were done on 40 donors. Of these donors, 31 (77.5%) reached the collection target with one leukapheresis. The product per LVL contained a mean 5.79+/-2.47 10(8)MNCs/kg and 11.6+/-10.62x10(6) CD34+ cells/kg respectively. Mean percentages of MNC were 79.88+/-22.15% and collection efficiencies of MNCs were inversely related to the starting MNC count (r=-0.536, P<0.001). After LVL, although none of the donors exhibited bleeding complications, platelets decreased from 187.4+/-52.68x10(3)/microL to 74.88+/-13.7x10(3)/microL and activated partial thromboplastin time (APTT) prolonged from 29.13+/-3.77 seconds to 67.51+/-54.26 seconds. CONCLUSION: We conclude that LVL after mobilization treatment with G-CSF and GM-CSF in normal healthy donors was tolerable and efficient methods for PBSCs collection, but long-term risk of adverse effects in normal donors needs to be carefully addressed by individual institutions as well as national and international registries.