Usefulness of BK virus-specific interferon-γ enzyme-linked immunospot assay for predicting the outcome of BK virus infection in kidney transplant recipients

Background/Aims@#To investigate if BK virus (BKV)-specific T cell immunity measured by an interferon-γ enzyme-linked immunospot (ELISPOT) assay can predict the outcome of BK virus infection in kidney transplant recipients (KTRs). @*Methods@#We included 68 KTRs with different viremia status (no viremia [n = 17], BK viremia [n = 27], and cleared viremia [n = 24]) and 44 healthy controls (HCs). The BK viremia group was divided into controller ( 3 months) according to sustained duration of BKV infection. We compared BKV-ELISPOT results against five BKV peptides (large tumor antigen [LT], St, VP1-3). @*Results@#BKV-ELISPOT results were higher in three KTRs groups with different BKV infection status than the HCs group (p < 0.05). In KTR groups, they were higher in cleared viremia group than no viremia or BK viremia group. Within the BK viremia group, controller group had higher LT-ELISPOT results compared to noncontroller group (p = 0.032). Also, KTRs without BK virus-associated nephropathy (BKVN) had higher LT, St, VP1, and VP2-ELISPOT results than those with BKVN (p < 0.05). @*Conclusions@#BKV-ELISPOT assay may be effective in predicting clinical outcomes of BKV infection in terms of clearance of BK virus and development of BKVN.

Experience of essay during the clinical clerkship in emergency medicine and inter-rater reliability on essay

Objective@#An essay test is difficult to carry out because of the effort for hand scoring and the concerns about inter-rater reliability, even though the use of a rubric can increase inter-rater reliability. This study examined the feasibility of an essay test in medical school students and whether the use of a rubric increases inter-rater reliability. @*Methods@#An essay test was given to 51 undergraduate students in the third grade of emergency medicine clinical clerkship. Three raters assessed the essay test independently with a prepared rubric immediately after the test. They then did the same essay test without a rubric three months later. The researchers compared the Pearson’s correlation coefficients between raters. The researchers analyzed the validity comparing the correlation coefficient between the essay test and previous multiple-choice questions (MCQ) and feasibility by acceptance. @*Results@#Fifty-one students took the essay test. The Pearson’s correlation coefficient using rubric between raters 1 and 2, 1 and 3, and 2 and 3 were 0.898 (P<0.001), 0.896 (P<0.001), and 0.856 (P<0.001), respectively. Without a rubric, the correlation coefficients were 0.838 (P<0.001), 0.888 (P<0.001), and 0.824 (P<0.001), respectively. The new essay test showed a positive correlation (0.367) with the previous MCQ, and the evidence for validity and feasibility was acceptable. @*Conclusion@#In this study, the rubric did not increase the inter-rater reliability of the essay test. On the other hand, the inter-rater reliability was higher than 0.8, even without a rubric. In addition, the essay test showed evidence of validity and feasibility.

Influence of Triggering Events on the Occurrence of Spontaneous Intracranial Hemorrhage : Comparison of Non-Lesional Spontaneous Intraparenchymal Hemorrhage and Aneurysmal Subarachnoid Hemorrhage

Objective@#: Spontaneous intracranial hemorrhage is a life-threatening disease, and non-lesional spontaneous intraparenchymal hemorrhage (nIPH) and aneurysmal subarachnoid hemorrhage (aSAH) are the leading causes of spontaneous intracranial hemorrhage. Only a few studies have assessed the association between prior physical activity or triggering events and the occurrence of nIPH or aSAH. The purpose of this study is to investigate the role of specific physical activities and triggering events in the occurrence of nIPH and aSAH. @*Methods@#: We retrospectively reviewed 824 consecutive patients with spontaneous intracranial hemorrhage between January 2010 and December 2018. Among the 824 patients, 132 patients were excluded due to insufficient clinical data and other etiologies of spontaneous intracranial hemorrhage. The medical records of 692 patients were reviewed, and the following parameters were assessed : age, sex, history of hypertension, smoking, history of stroke, use of antiplatelet or anticoagulation agents, season and time of onset, physical activities performed according to the metabolic equivalents, and triggering event at onset. Events that suddenly raised the blood pressure such as sudden postural changes, defecation or urination, sexual intercourse, unexpected emotional stress, sauna bath, and medical examination were defined as triggering events. These clinical data were compared between the nIPH and aSAH groups. @*Results@#: Both nIPH and aSAH most commonly occurred during non-strenuous physical activity, and there was no significant difference between the two groups (p=0.524). Thirty-two patients (6.6%) in the nIPH group and 39 patients (8.1%) in the aSAH group experienced triggering events at onset, and there was a significant difference between the two groups (p=0.034). The most common triggering events were defecation or urination in both groups. @*Conclusion@#: Specific physical activity dose no affect the incidence of nIPH and aSAH. The relationship between the occurrence of intracranial hemorrhage and triggering events is higher in aSAH than nIPH.

Artificial Intelligence in Health Care: Current Applications and Issues

In recent years, artificial intelligence (AI) technologies have greatly advanced and become a reality in many areas of our daily lives. In the health care field, numerous efforts are being made to implement the AI technology for practical medical treatments. With the rapid developments in machine learning algorithms and improvements in hardware performances, the AI technology is expected to play an important role in effectively analyzing and utilizing extensive amounts of health and medical data. However, the AI technology has various unique characteristics that are different from the existing health care technologies. Subsequently, there are a number of areas that need to be supplemented within the current health care system for the AI to be utilized more effectively and frequently in health care. In addition, the number of medical practitioners and public that accept AI in the health care is still low;moreover, there are various concerns regarding the safety and reliability of AI technologyimplementations. Therefore, this paper aims to introduce the current research and application status of AI technology in health care and discuss the issues that need to be resolved.

Causes of food allergy according to age and severity: A recent 10-year retrospective study from a single tertiary hospital

Purpose@#Recent studies of food allergy (FA) at all ages are scanty in Korea. We performed this study to better understand severity-related and age-stratified causes of FA from infants to older adults in a single tertiary hospital in Korea. @*Methods@#A retrospective medical record review was performed on patients of all ages diagnosed with immediate-type FA between March 2008 and February 2018 in Ajou University Hospital. @*Results@#A total of 4,680 cases of FA among 2,733 patients were reported. The distribution of onset ages of the first FA symptom was as follows: 45.3% below 2 years, 16.2% at 2–6 years, 5.5% at 7–12 years, 4.0% at 13–18 years, 16.9% at 19–40 years, 10.4% at 41–65 years, and 1.8% above 65 years of age. The major 10 causative foods were hen’s eggs (17.2%), cow’s milk (16.7%), wheat (8.6%), crustaceans (8.5%), fish (4.6%), walnuts (4.4%), pork (3.2%), peanuts (3.2%), shellfish (3.0%), and peach (2.2%). The culprits ranked from the 11th to the 20th were as follows: soybean, apple, chicken, buckwheat, beef, kiwi, almonds, perilla seeds, tomato, and squid. The top 3 causative foods in children were hen’s eggs, cow’s milk, and wheat, while those in adults were crustaceans, wheat, and fish. Food-induced anaphylaxis was reported in 29.2% of all cases, with cow’s milk, hen’s eggs, wheat, crustaceans, fish, walnuts, pork, shellfish, buckwheat, and peanuts being the major 10 causes. @*Conclusion@#This study could provide a better understanding of the detailed ranks of the causes of FA according to severity and age in Korea.

Educational Interventions to Enhance Adherence to Prophylactic Treatment in Korean Hemophilia Patients / 임상소아혈액종양

BACKGROUND: A patient's adherence to prophylactic treatment is one of the most significant factors to achieve desired outcomes, in regards to the quality of life and treatment cost-effectiveness. The aim of this study is to evaluate the effectiveness of educational interventions in enhancing adherence to prophylactic treatment in Korean hemophilia patients. METHODS: The Validated Hemophilia Regimen Treatment Adherence Scale-Prophylaxis (VERITAS-Pro) was used to measure adherence. The study design consisted of two groups. One group was not educated with the education card which presented the morning administration of clotting factor concentrates and self-infusion skill. The other group was educated with the card. The scores of each subscale in the two groups and scores focused on the ‘Timing’ subscale were compared. RESULTS: Participants were recruited from five hemophilia treatment centers in Korea with 95 eligible patients forming the uneducated group and 123 patients in the educated group. The mean total score was 40.4 and 39.9, respectively. The subscale mean scores of the uneducated group and educated group were 8.43 and 7.90 (Timing), 6.12 and 5.88 (Dosing), 6.43 and 6.33 (Planning), 5.99 and 6.35 (Remembering), 6.22 and 6.25 (Skipping), and 7.23 and 7.24 (Communicating), respectively. CONCLUSION: Results showed that education programs on prophylactic treatment for hemophilia patients need to be well-designed with precise and subject-appropriate contents. Although the mean total scores of VERITAS-Pro could not be improved, the appropriate timing of injection with the educational intervention was administered. Results suggest that this whole process can enhance Korean hemophilia patients' adherence to prophylactic treatment.

Low-Level Laser Irradiation Improves Motor Recovery After Contusive Spinal Cord Injury in Rats

This study investigated the therapeutic effects of low-level laser irradiation (LLLI) on the recovery of motor function and its underlying mechanisms in rats with spinal cord injury (SCI). The spinal cord was contused at the T11 level using a New York University impactor. Thirty-eight rats were randomly divided into four groups: LLLI with 0.08 J, 0.4 J, 0.8 J, and sham. We transcutaneously applied at the lesion site of the spinal contusive rats 5 min after injury and then daily for 21 days. The Basso, Beattie and Bresnahan (BBB) locomotor scale and combined behavioral score (CBS) were used to evaluate motor function. The spinal segments of rostral and caudal from the lesion site, the epicenter, and L4–5 were collected from normal and the all groups at 7 days after SCI. The expression of tumor necrosis factor-α (TNF-α) and inducible nitric oxide synthase (iNOS) was compared across groups in all regions. In the present study, LLLI with 0.4 J and 0.8 J led to a significant improvement in motor function compared to sham LLLI, which significantly decreased TNF-α expression at the lesion epicenter and reduced iNOS expression in the caudal segment for all LLLI groups and in the L4–5 segments for the 0.4 J and 0.8 J groups when compared to sham LLLI group. Our results demonstrate that transcutaneous LLLI modulate inflammatory mediators to enhance motor function recovery after SCI. Thus, LLLI in acute phase after SCI might have therapeutic potential for neuroprotection and restoration of motor function following SCI.

A first case of high-flow nasal cannula oxygen therapy in patients with pulmonary tumor thrombotic microangiopathy

No abstract available.

A first case of high-flow nasal cannula oxygen therapy in patients with pulmonary tumor thrombotic microangiopathy

No abstract available.

The effects of intra-articular resiniferatoxin on monosodium iodoacetate-induced osteoarthritic pain in rats

This study was performed to investigate whether an intra-articular injection of transient receptor potential vanilloid 1 (TRPV1) receptor agonist, resiniferatoxin (RTX) would alleviate behavioral signs of arthritic pain in a rat model of osteoarthritis (OA). We also sought to determine the effect of RTX treatment on calcitonin gene-related peptide (CGRP) expression in the spinal cord. Knee joint inflammation was induced by intra-articular injection of monosodium iodoacetate (MIA, 8 mg/50 microl) and weight bearing percentage on right and left hindpaws during walking, paw withdrawal threshold to mechanical stimulation, and paw withdrawal latency to heat were measured to evaluate pain behavior. Intra-articular administration of RTX (0.03, 0.003 and 0.0003%) at 2 weeks after the induction of knee joint inflammation significantly improved reduction of weight bearing on the ipsilateral hindlimb and increased paw withdrawal sensitivity to mechanical and heat stimuli. The reduction of pain behavior persisted for 3~10 days according to each behavioral test. The MIA-induced increase in CGRP immunoreactivity in the spinal cord was decreased by RTX treatment in a dose-dependent manner. The present study demonstrated that a single intra-articular administration of RTX reduced pain behaviors for a relatively long time in an experimental model of OA and could normalize OA-associated changes in peptide expression in the spinal cord.

Study on the biodegradation of perfluorooctanesulfonate (PFOS) and PFOS alternatives

OBJECTIVES: In this study, we investigated the biodegradation features of 4 perfluorooctanesulfonate (PFOS) alternatives developed at Changwon National University compared to those of PFOS. METHODS: Biodegradation testing was performed with microorganisms cultured in the good laboratory practice laboratory of the Korea Environment Corporation for 28 days following the Organization for Economic Cooperation and Development guidelines for the testing of chemicals (Test No. 301 C). RESULTS: While C₈F₁₇SO₃Na, PFOS sodium salt was not degraded after 28 days, the 4 alternatives were biodegraded at the rates of 20.9% for C₁₅F₉H₂₁S₂O₈Na₂, 8.4% for C₁₇F₉H ₂₅S₂O₈Na₂, 22.6% for C₂₃F₁₈H₂₈S₂O₈Na₂, and 23.6% for C₂₅F₁₇H₃₂O₁₃S₃Na₃. CONCLUSIONS: C₂₅F₁₇H₃₂S₃O₁₃Na₃, C₂₃F₁₈H₂₈S₂O₈Na₂, and C₁₅F₉H₂₁S₂O₈Na₂ were superior to PFOS in terms of biodegradation rates and surface tension, and thus they were considered highly applicable as PFOS alternatives. Environmental toxicity, human toxicity, and economic feasibility of these compounds should be investigated prior to their commercialization.

Left Paraduodenal Hernia in a 3-year-child

Internal hernia is an uncommon cause of intestinal obstruction, accounting for 1%. The most common cause of internal hernia is left paraduodenal hernia (PDH), which causes acute or recurrent abdominal pain. Due to its nonspecific symptoms, diagnosis of PDH by physical examination is difficult. PDH in children is rarely reported. A 3-year-old-child presented with acute abdominal pain associated with multiple episodes of vomiting. He came to the emergency room three times with abdominal pain. Left PDH was identified by computed tomography. He was taken to the operating room. However cardiac arrest occurred during anesthesia, and he expired. Due to the rarity of PDH in children, it is difficult to consider it as a cause of recurrent abdominal pain. Therefore, considering the possibility of PDH in children with acute or recurrent abdominal pain is recommended.

Association of TLR3 gene polymorphism with IgG subclass deficiency and the severity in patients with aspirin-intolerant asthma

PURPOSE: Toll-like receptor 3 (TLR3) recognizes to viral double-stranded RNA and is involved in antiviral defenses. A probable role of TLR3 gene variants in the pathogenesis of aspirin-intolerant asthma (AIA) has been suggested. AIA patients present more frequent asthma exacerbations in which respiratory viral infections could be an exacerbating factor. IgG subclass deficiency was commonly present with bronchial asthma. Based on previous findings, we investigated whether TLR3 variants could affect IgG3 subclass deficiency in AIA. METHODS: We enrolled 279 AIA patients, 403 aspirin-tolerant asthma (ATA) patients, and 315 normal healthy controls (NC) in this study. TLR3 polymorphism at the promoter region -299698G>T was genotyped. The serum levels of IgG subclasses were determined by the single radial immunodiffusion method. Expressions of IgG3 and TLR3 on Epstein-Barr virus transformed-B cells isolated from asthmatic patients were evaluated by flow cytometry to investigate B-cell functions. RESULTS: The TLR3 -299698 T allele was significantly associated with severity and IgG3 deficiency in the AIA group (P=0.044 and P=0.010, respectively), but not in the ATA group. IgG3 expression on B cells from asthmatics with IgG3 deficiency was significantly lower compared to those without (P=0.025). There was a positive correlation between IgG3 expression levels on B cells and serum IgG3 levels (r 2=0.434, P=0.002). CONCLUSION: These results suggest that the TLR3 -299698G>T polymorphism may be associated with IgG3 subclass deficiency and severity in AIA.

Existing test data for the Act on Registration & Evaluation, etc. of Chemical Substances

OBJECTIVES: In this study, the possibility of using existing test data provided in Korea and elsewhere for the registration of chemical substances was examined. Data on 510 chemical substances that are among the first subject to registration under the “Act on the Registration and Evaluation, etc. of Chemical Substances (K-REACH)” were analyzed. METHODS: The possibility of using existing data from 16 reference databases was examined for 510 chemical substances notified in July 2015 as being subject to registration. RESULTS: Test data with the reliability required for the registration of chemical substances under the K-REACH constituted 48.4% of the required physicochemical characteristics, 6.5% of the required health hazards, and 9.4% of the required environmental hazards. CONCLUSIONS: Some existing test data were not within the scope of this research, including data used for registration in the European Union (EU). Thus, considering that 350 of these 510 species are registered in EU Registration, Evaluation, Authorisation & Restriction of Chemicals, more test data may exist that can be utilized in addition to the data identified in this study. Furthermore, the K-REACH states that non-testing data (test results predicted through Read Across, Quantitative Structure- Activity Relationships) and the weight of evidence (test results predicted based on test data with low reliability) can also be utilized for registration data. Therefore, if methods for using such data were actively reviewed, it would be possible to reduce the cost of securing test data required for the registration of chemical substances.

Existing test data for the Act on Registration & Evaluation, etc. of Chemical Substances

OBJECTIVES: In this study, the possibility of using existing test data provided in Korea and elsewhere for the registration of chemical substances was examined. Data on 510 chemical substances that are among the first subject to registration under the “Act on the Registration and Evaluation, etc. of Chemical Substances (K-REACH)” were analyzed. METHODS: The possibility of using existing data from 16 reference databases was examined for 510 chemical substances notified in July 2015 as being subject to registration. RESULTS: Test data with the reliability required for the registration of chemical substances under the K-REACH constituted 48.4% of the required physicochemical characteristics, 6.5% of the required health hazards, and 9.4% of the required environmental hazards. CONCLUSIONS: Some existing test data were not within the scope of this research, including data used for registration in the European Union (EU). Thus, considering that 350 of these 510 species are registered in EU Registration, Evaluation, Authorisation & Restriction of Chemicals, more test data may exist that can be utilized in addition to the data identified in this study. Furthermore, the K-REACH states that non-testing data (test results predicted through Read Across, Quantitative Structure- Activity Relationships) and the weight of evidence (test results predicted based on test data with low reliability) can also be utilized for registration data. Therefore, if methods for using such data were actively reviewed, it would be possible to reduce the cost of securing test data required for the registration of chemical substances.

Study on the biodegradation of alternatives (four species including C8H8F9KO3S) for perfluorooctane sulfonate

OBJECTIVES: The objective of this study was to evaluate the biodegradation potential of four perfluorooctane sulfonic acid (PFOS) alternatives that were developed at Changwon National University. While PFOS has been used widely in industrial and consumer products, it is known to be a persistent organic pollutant. Therefore, greener alternatives are highly desirable. METHODS: Biodegradation tests were run for 28 days using standard test protocols. The biochemical oxygen demand was measured daily throughout the experimental period, and the data were used to calculate the biodegradation rates. Microorganisms were isolated from the some of the tests that showed evidence of biodegradation. RESULTS: C8H8F9KO3S, which has the same number of carbons as the parent compound PFOS but a reduced number of fluorines, showed the highest biodegradation rate followed by C10H8F13KO3S. Chemical alternatives with lower number of carbons did not biodegrade readily in the experiments. CONCLUSIONS: Together, these results suggest that it may be advantageous to develop PFOS alternatives with 8 carbons, the same as PFOS, but a reduced number of fluorines; as such, chemicals are more susceptible to biodegradation than the parent compound.

Imaging Mass Spectrometry in Papillary Thyroid Carcinoma for the Identification and Validation of Biomarker Proteins

Direct tissue imaging mass spectrometry (IMS) by matrix-assisted laser desorption ionization and time-of-flight (MALDI-TOF) mass spectrometry has become increasingly important in biology and medicine, because this technology can detect the relative abundance and spatial distribution of interesting proteins in tissues. Five thyroid cancer samples, along with normal tissue, were sliced and transferred onto conductive glass slides. After laser scanning by MALDI-TOF equipped with a smart beam laser, images were created for individual masses and proteins were classified at 200-microm spatial resolution. Based on the spatial distribution, region-specific proteins on a tumor lesion could be identified by protein extraction from tumor tissue and analysis using liquid chromatography with tandem mass spectrometry (LC-MS/MS). Using all the spectral data at each spot, various intensities of a specific peak were detected in the tumor and normal regions of the thyroid. Differences in the molecular weights of expressed proteins between tumor and normal regions were analyzed using unsupervised and supervised clustering. To verify the presence of discovered proteins through IMS, we identified ribosomal protein P2, which is specific for cancer. We have demonstrated the feasibility of IMS as a useful tool for the analysis of tissue sections, and identified the tumor-specific protein ribosomal protein P2.

Lumbocostovertebral Syndrome with Congenital Bilateral Lumbar Hernia / 대한주산의학회잡지

Lumbocostovertebral syndrome is a rare type of congenital lumbar hernia. Its features include lumbar hernia associated with genitourinary, vertebral, and rib anomalies. About 30 cases have been reported in the English literature, but in Korea, there has not been a case reported. We experienced a neonate with multiple costovertebral anomalies and bilateral lumbar hernia with liver and small intestine herniation diagnosed by physical examination and computed tomography. We report a case of a congenital lumbocostovertebral syndrome in neonate with literature review.

The Assessment of a Patient's Chief Complaints by Emergency Medical Technicians and Residents of an Emergency Department

PURPOSE: Addressing a patient's chief complaint is the first and key element of treating patients. This study determined the effectiveness of emergency medical technician and residents of an emergency department in addressing a patient's chief complaints. If emergency and hospital personnel misunderstand the chief symptoms of patients it could result in erroneous transport and treatment, thus losing precious time in finding the proper treatment. METHODS: A retrospective chart review study was performed in 1137 patients (at least 18 years of age), who visited one university hospital, for a period of 3 months. Patients who were did not undergo trauma, addiction, and cardiac arrest were included. RESULTS: A total of 150 cases (13.2%) did not match the chief symptoms reported by 119 emergency medical personnel and emergency medicine residents. Systemic symptoms, nervous system symptoms, and psychiatric symptoms were the main categories inconsistently assessed. The rank and certification of emergency medical technicians did not make a difference, but older patients (59 years of age or older) were statistically different. The assessment fo chief symptoms by an emergency medical resident tended to be more accurate than assessment of emergency medical technicians in the final diagnosis. CONCLUSION: Systemic symptoms, nervous symptoms, and psychiatric symptoms, were chief complaines easily misreported for older patients. This likely reflects a difficulty in the evaluation of obscure symptoms in older patients. It will require specific additional training programs to improve the response to these chief complaints.

Performance Enhancement with Low Stress and Anxiety Modulated by Cognitive Flexibility

OBJECTIVE: The purpose of this study was to compare cognitive flexibility abilities, stress, and anxiety between starters and non-starter athletes. METHODS: A total of 30 male professional-soccer and 40 professional-baseball athletes were recruited. Wisconsin Card Sorting Test (WCST) and Trail Making Test A & B (TMT A & B) were administered to assess cognitive flexibility during competition. The Korean version of the STAI form Y (STAI-KY) and Visual analogue scale for anxiety and stress were used to assess the anxiety and stress. RESULTS: The starter group had better cognitive function (fewer perseverative errors and rapid TMTB times) (Z=3.32, p<0.01; Z=2.20, p=0.03, respectively) and lower stress and anxiety (F=4.34, p=0.01; F=6.61, p<0.01, respectively) during competition than the non-starter group. CONCLUSION: The better cognitive performances were negatively correlated with stress and anxiety. Current results suggested that cognitive flexibility would enhance human performance by modulation of the anxiety and stress during competition.