Impact of Post-Transplant Diabetes Mellitus on Survival and Cardiovascular Events in Kidney Transplant Recipients

Background@#Post-transplant diabetes mellitus (PTDM) is a risk factor for poor outcomes after kidney transplantation (KT). However, the outcomes of KT have improved recently. Therefore, we investigated whether PTDM is still a risk factor for mortality, major atherosclerotic cardiovascular events (MACEs), and graft failure in KT recipients. @*Methods@#We studied a retrospective cohort of KT recipients (between 1994 and 2017) at a single tertiary center, and compared the rates of death, MACEs, overall graft failure, and death-censored graft failure after KT between patients with and without PTDM using Kaplan-Meier analysis and a Cox proportional hazard model. @*Results@#Of 571 KT recipients, 153 (26.8%) were diagnosed with PTDM. The mean follow-up duration was 9.6 years. In the Kaplan- Meier analysis, the PTDM group did not have a significantly increased risk of death or four-point MACE compared with the non-diabetes mellitus group (log-rank test, P=0.957 and P=0.079, respectively). Multivariate Cox proportional hazard models showed that PTDM did not have a negative impact on death or four-point MACE (P=0.137 and P=0.181, respectively). In addition, PTDM was not significantly associated with overall or death-censored graft failure. However, patients with a long duration of PTDM had a higher incidence of four-point MACE. @*Conclusion@#Patient survival and MACEs were comparable between groups with and without PTDM. However, PTDM patients with long duration diabetes were at higher risk of cardiovascular disease.

Frontline Chinese Herbal Medicine: the Use of Sanyao Sanfang against COVID-19 / 日本補完代替医療学会誌

The rapid spread of COVID-19, which was first reported in Wuhan, China, gave unprecedented impacts to the peoplearound the globe. Since no current established treatments nor medications are available, medical professionals are longing for the effective tools to fight against COVID-19. The true value of Chinese herbal medicine can be seen under such tough circumstances. The effects of Sanyao Sanfang, containing various naturally occurring phytochemicals were reported from the epicenter of COVID-19 in China. The distinctive feature of the Sanyao Sanfang is its ability to strengthen vitality of the body and improved resistance against invasive attacks by viruses and microbes. It also promotes activation of the immune system and its recovery to healthy status. It is obvious that the comprehensive effects of the Sanyao Sanfang do not stem from a single substance. Further studies are warranted for clarification of the mechanism and the role of other raw materials, as well as for the improvement of its formulation, efficacy and safety.

Development of Virtual Reality-based Visual Perception and Cognitive Rehabilitation Service

PURPOSE: Patients with brain damage suffer from limitations in performing the activities of daily living (ADL) because of their motor function and visual perception impairment. The aim of this study was to help improve the motor function and visual perception ability of patients with brain damage by providing them with virtual reality-based contents. The usability results of the patients and specialists group were also evaluated. METHODS: The ADL contents consisted of living room, kitchen, veranda, and convenience store, similar to a real home environment, and these were organized by a rehabilitation specialist (e.g., neurologist, physiotherapist, and occupational therapist). The contents consisted of tasks, such as turning on the living room lights, organizing the drawers, organizing the kitchen, watering the plants on the veranda, and buying products at convenience stores. To evaluate the usability of the virtual reality-based visual cognitive rehabilitation service, general elderly subjects (n=11), stroke patients (n=7), stroke patients with visual impairment (n=4), and rehabilitation specialists (n=11) were selected. The questionnaires were distributed to the subjects who were using the service, and the subjective satisfaction of individual users was obtained as data. The data were analyzed using SPSS 21.0 software. The general characteristics of the users and the evaluation scores of the experts were analyzed using descriptive statistics. RESULTS: The usability test result of this study showed that the mean value of the questionnaire related to content understanding and difficulty was high, between 4–5 points. CONCLUSION: The virtual reality rehabilitation service of this study is an efficient service that can improve the function, interest, and motivation of stroke patients.

Diversity of Plant Species in The Steel City of Odisha, India: Ethnobotany and Implications for Conservation of Urban Bio-Resources

ABSTRACT The vegetation of the Steel City (Rourkela) of Odisha, India has high ethnobotanical values by virtue of its rich floral diversity. People in the urban area are highly dependent on the plants available in and around the city for their primary needs. The present study highlights the use of local flora, explore, identification, ethnobotany and conservation of wild and cultivated plant species in the city of Rourkela, Odisha, India. It also pays heed to the proper utilization of urban flora as a way of highlighting its ethnopharmacological importance. A field survey was conducted to collect information about floral diversity in and around the city. Data on the use of plants was collected with a semi-structured questionnaire and from the peer-reviewed literature. A total of 154 plant species, belonging to 128 genera and 55 families, were identified, along with their botanical name, vernacular name, family and habitat. Of these plant species, 53 are medicinal, 43 are ornamental, and 33 are edible, while 23 are weeds. Paderia foetida and Saraca asoka fall into the RET (rare, endangered and threatened) group and are very effective against various diseases. Traditional uses of local plants in an urban area like Rourkela are very interesting. This shows that, not only rural and tribal areas are rich in useful bio-resources but so are urban or semi-urban areas. The documentation of all useful flora with ethnomedicinal potential is helpful in conserving plant biodiversity as well as in environmental studies along with potential applications in drug discovery and oriental medicine.

Evaluation of Medicinal Values of Gymnopetalum chinense (Lour.) Merr., a Lesser Known Cucurbit from Eastern Ghats of India

ABSTRACT >The in vitro antimicrobial activity of Gymnopetulum chinense (Cucurbitaceae), a lesser known climber of Eastern Ghats and recently recorded species from Odisha, India was studied against five selected human pathogenic bacteria (Streptococcus mutans, S. pyogenes, Vibrio cholerae, Shigella flexneri and Salmonella typhi), by agar well diffusion (AWD), disc diffusion (DD) and broth dilution methods. Different solvent extracts were prepared from the leaves of G. chinense using various solvents viz. n-hexane, chloroform, methanol, acetone and aqueous. The nomenclature, detailed description and photographs of the plant are provided to facilitate its easy identification. The leaf extract showed presence of phenolic compounds, tannin, saponin, flavonoids and glycosides. It was examined that methanol extract showed highest zone of inhibition (16.66 mm) against S. pyogenes using DD assay. Similar results were examined as lowest MIC values were found with methanol leaf extract against S. pyogenes and S. mutans (200 µg/ml). Present study showed first report of this plant as natural antibacterial agents and highlights the importance of G. chinense in curing the bacterial infections.

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Associated with Mediastinal Schwannoma

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hypo-osmotic hyponatremia. There are several etiologies of SIADH including neuroendocrine tumor, pulmonary disease, infection, trauma, and medications. Here, we report a case of SIADH associated with a schwannoma involving the mediastinum in a 75-year-old woman who presented with nausea, vomiting, and general weakness. Laboratory testing showed hypo-osmolar hyponatremia, with a serum sodium level of 102mmol/L, serum osmolality of 221mOsm/kg, urine osmolality of 382mOsm/kg, urine sodium of 55 mmol/L, and plasma antidiuretic hormone (ADH) of 4.40 pg/mL. Chest computed tomography identified a 1.5-cm-sized solid enhancing nodule in the right lower paratracheal area. A biopsy specimen was obtained by video-assisted thoracoscopic surgery, which was diagnosed on pathology as a schwannoma. The hyponatremia was completely resolved after schwannoma resection and plasma ADH level decreased from 4.40 pg/mL to 0.86 pg/mL. This case highlights the importance of suspecting and identifying the underlying cause of SIADH when faced with refractory or recurrent hyponatremia, and that on possibility is mediastinal schwannoma

Ovarian Volume in Korean Women with Polycystic Ovary Syndrome and Its Related Factors

OBJECTIVES: The aim of this study was to determine the relationship of ovarian volume (OV) to age, height, and weight in Korean young women with the polycystic ovary syndrome (PCOS) undergoing ultrasonography (US) and to investigate the relationship between ovarian follicle count and volume on US and serum hormone levels including the levels of the anti-Müllerian hormone (AMH) and gonadotropin. METHODS: A total of 272 Korean nulliparous women aged 15 to 39 years who were newly diagnosed with PCOS at a university hospital were included in this study. Evaluation of the ovaries and measurement of OVs in all cases were randomly performed by ultrasound. The OV and follicle number (FN) were obtained in all cases. RESULTS: In Korean women with PCOS, mean OV was 7.9 ± 3.6 cm3 (right) and 6.7 ± 3.1 cm3 (left). Mean FN in the PCOS group was 14.2 ± 4.6 (right) and 13.8 ± 4.3 (left). OV and ovarian FN were unrelated to patient weight, height and body mass index. The left ovarian FN was related to patient age. AMH levels ranged from 5.31 to 43.1 ng/mL and the mean level was 13.9 ± 7.2 ng/mL. Serum AMH was related to OV and FN, and serum total testosterone was related to FN in Korean women with PCOS. CONCLUSIONS: In Korean nulliparous women with PCOS, OV was smaller than that in other ethnic groups and the right OV was larger than the left OV. Ovarian FN, AMH, testosterone are good markers for the diagnosis of PCOS in Korean women.

Post-transplant Lymphoproliferative Disorder in Transplanted Kidney Causing Urinary Tract Obstruction / 대한이식학회지

Post-transplant lymphoproliferative disorder (PTLD) is a serious complication resulting in mortality and renal graft failure. PTLD is a heterogeneous disorder, which causes different clinical forms of disease from non-specific viral syndrome to malignant lymphoma and has various etiologies, clinical features, and treatment strategies. Here, we report on a patient who had a PTLD in the hilum of a transplanted kidney at 5 months after renal transplantation. The PTLD resulted in hydronephrosis of the transplanted kidney and graft dysfunction by local urinary tract obstruction. Despite treatment including immunosuppression reduction and rituximab administration, we removed the transplanted kidney from the recipient because the PTLD did not respond to the therapy.

Participation in Leisure Activity and Exercise of Chronic Stroke Survivors Using Community-Based Rehabilitation Services in Seongnam City

OBJECTIVE: To clarify how participation in leisure activities and exercise by chronic stroke survivors differs before and after a stroke. METHODS: Sixty chronic stroke survivors receiving community-based rehabilitation services from a health center in Seongnam City were recruited. They completed a questionnaire survey regarding their demographic characteristics and accompanying diseases, and on the status of their leisure activities and exercise. In addition, their level of function (Korean version of Modified Barthel Index score), risk of depression (Beck Depression Inventory), and quality of life (SF-8) were measured. RESULTS: After their stroke, most of the respondents had not returned to their pre-stroke levels of leisure activity participation. The reported number of leisure activities declined from a mean of 3.9 activities before stroke to 1.9 activities post-stroke. In addition, many participants became home-bound, sedentary, and non-social after their stroke. The most common barriers to participation in leisure activities were weakness and poor balance, lack of transportation, and cost. The respondents reported a mean daily time spent on exercise of 2.6+/-1.3 hours. Pain was the most common barrier to exercise participation. CONCLUSION: Chronic stroke survivors need information on leisure activities and appropriate pain management.

Neuropsychological and Psychiatric Impairment after West Nile Virus Encephalitis in Korean: A Case Report

West Nile virus (WNV) is the most widespread arbovirus in the world. It can cause serious or fatal central nervous system (CNS) infection. We present a case of 58-year-old man who developed neuropsychologic and psychiatric impairment such as cognitive impairment, depressive symptoms, health concerns and thought disorder after West Nile virus encephalitis. This is the first imported case of West Nile virus infection in Korean.

Survey of food allergy in elementary school children in Bucheon-city and relationship between food allergy and other allergic diseases

PURPOSE: This study was performed to evaluate the current status of food allergy (FA) and to analyze the relationship between allergy to individual foods and other allergic diseases in elementary school children. METHODS: We performed a questionnaire survey for FA, asthma, allergic rhinitis, and atopic dermatitis using International Study of Asthma and Allergies in Childhood questionnaires. A total of 1,929 students in 3 elementary schools were enrolled. RESULTS: A total of 324 students (16.8%) had ever suffered from FA symptoms more than once. Only 64 out of 324 students (19.8%) were diagnosed with FA by doctors. The presence of soy allergy was associated with the increased risk of bronchial asthma (adjusted odds ratio [aOR], 5.90; 95% confidence interval [CI], 1.87 to 18.59). The presence of egg (aOR, 1.91; 95% CI, 1.04 to 3.52) and wheat allergy (aOR, 5.45; 95% CI, 1.94 to 15.36) were associated with the increased prevalence of allergic rhinitis. The allergic symptoms to fruits/tomato was associated with the increased risk of allergic rhinoconjunctivitis symptoms (aOR, 2.98; 95% CI, 1.18 to 7.47). The allergic symptoms to egg (aOR, 2.29; 95% CI, 1.22 to 4.29), wheat (aOR, 4.91; 95% CI, 1.86 to 12.95), and shrimp/crab (aOR, 2.48; 95% CI, 1.37 to 4.49) were associated with the presence of atopic dermatitis. CONCLUSION: The prevalence of FA of elementary school students in Bucheon-city was 16.8%. A significant positive association between the suspected foods and the other allergic diseases was found. Soy allergy was significantly correlated to having bronchial asthma and fruits/tomato allergy correlated with allergic rhinoconjunctivitis.

Leukocytoclastic Vasulitis Induced by Methoxy Polyethylene Glycol-Epoetin Beta / 대한피부과학회지

Methoxy polyethylene glycol-epoetin beta (Mircera(R), Roche), a third-generation erythropoiesis-stimulating agent (ESA) is known as a continuous erythropoietin receptor activator (CERA). In patients with anemia associated with chronic kidney disease (CKD), it is administered intravenously or subcutaneously. Treatment-related adverse events induced by methoxy polyethylene glycol-epoetin beta occurred in 6%. Hypertension, diarrhea and nasopharyngitis were the most commonly reported adverse events. Cutaneous adverse reactions are rarely experienced with methoxy polyethylene glycol-epoetin beta including maculopapular eruption, facial erythema, and tinea pedis. To the best of our knowledge, no cases of leukocytoclastic vasculitis associated with methoxy polyethylene glycol-epoetin beta have ever been published in medical literature. Herein, we report on a case of leukocytoclastic vasulitis induced by methoxy polyethylene glycol-epoetin beta in a patient with anemia associated with chronic kidney disease.

Giant Congenital Melanocytic Nevus with Multiple Satellite Lesions in a Korean Woman with Mental Retardation / 대한피부과학회지

Giant congenital melanocytic nevi (GCMN) are defined as melanocytic nevi that are greater than 20 cm in largest dimension at birth. GCMN is a relatively rare condition, affecting approximately 1 in 20,000 newborns. Patients with GCMN on the posterior axis and in the presence of many satellite nevi are associated with neurocutaneous melanosis. A 37-year-old female with mental retardation had dark brown nevi with hair on her back (paraspinal) and on her lower extremities. In addition, she has multiple satellite lesions distributed over her trunk and extremities. Herein, we present a case that demonstrates a relationship between CNS abnormality and multiple satellite nevus in GCMN patients with a review of the relevant literature.

A Clinical Study on Viral Warts in Five-Year-Period (2007~2011) / 대한피부과학회지

BACKGROUND: Viral warts are common viral infections and are usually self-limiting. However, there have been few studies assessing the characteristics of patients with viral warts. OBJECTIVE: The purpose of this study was to assess the epidemiological and clinical characteristics of viral warts during a five-year-period. METHODS: We carried out a retrospective analysis of patients with viral warts who had been diagnosed in the Myongji hospital from January 2007 to December 2011. RESULTS: One thousand seven hundred and ninety patients with viral warts were assessed. A group of patients aged under 10 years had the highest occurrence of common warts (46.8%). The mean age was 16.9 years. Hands (47.7%) were more commonly involved than feet (36.4%). Cryotherapy was used to treat most of the patients. One thousand and sixty-one patients (59.3%) showed complete resolution of the wart lesion in the clinical ground. CONCLUSION: The number of patients with viral warts is currently increasing. This study provides useful data on the prevalence and characteristics of viral warts.

Reliability of the Supraspinatus Muscle Thickness Measurement by Ultrasonography

OBJECTIVE: To assess the intrarater and interrater reliability of the supraspinatus thickness measured by ultrasonography (US) in normal subjects and to identify the relationship between the supraspinatus thickness measured by US and cross sectional area (CSA) of the supraspinatus muscle by magnetic resonance imaging (MRI) in hemiplegic patients. METHOD: We examined 20 shoulders of normal subjects and 10 shoulders of hemiplegic patients. In normal subjects, one examiner measured the supraspinatus thickness twice by US at the scapular notch and another examiner measured the supraspinatus thickness several days later. The intrarater and interrater reliability of supraspinatus thickness measurements were then evaluated. In hemiplegic patients, the supraspinatus thickness at the scapular notch was measured by US in affected side and compared with CSA of the supraspinatus muscle at the scapular notch and the Y-view of MRI. RESULTS: One examiner's supraspinatus thickness measurement average was 1.72+/-0.21 cm and 1.74+/-0.24 cm, and the other examiner's supraspinatus thickness measurement average was 1.74+/-0.22 cm in normal subjects. Intraclass correlation coefficients of intrarater and interrater examination were 0.91 and 0.88, respectively. For hemiplegic patients, the supraspinatus thickness measured by US was 1.66+/-0.13 cm and CSA by MRI was 4.83+/-0.88 cm2 at the Y-view and 5.61+/-1.19 cm2 at the scapular notch. The Pearson Correlation Coefficient between the supraspinatus thickness at the scapular notch and the CSA at the Y-view was 0.72 and that between the supraspinatus thickness and CSA at the scapular notch was 0.76. CONCLUSION: The supraspinatus thickness measurement by US is a reliable method and is positively correlated with the CSA of the supraspinatus muscle in MRI in hemiplegic patients. Therefore, supraspinatus thickness measurement by US can be used in the evaluation of muscle atrophy and to determine therapeutic effects in hemiplegic patients.

Linear Psoriasis Localized on Unilateral Arm - A Rare Variant of Psoriasis / 대한피부과학회지

Psoriasis vulgaris is one of the most common skin diseases in the world, which is recognized as an autoimmune disease that is caused by genetic and environmental factors. Plaque, guttate, pustular form, and psoriatic erythroderma are known as classical feature of psoriasis with tendency as generalized or sporadic appearance. There are some cases of uncommon forms in the shape and distribution, as nevoid and linear psoriasis. Linear psoriasis is a rare entity and thought as a variant of psoriasis, but its existence is still in debate. Herein, we report an interesting case of 19-year old Korean man with psoriasis, occurring on the right arm, following the line of Blaschko in a linear form.

Erythema Elevatum Diutinum in Human Immunodeficiency Virus Infected Patient / 감염과화학요법

Erythema elevatum diutinum (EED) is emerging as a specific HIV-associated dermatosis which can be easily misdiagnosed as Kaposi's sarcoma or bacillary angiomatosis. Until now, no case of HIV-associated EED had been reported in Korea. We report a case of EED in a 49-year-old man with HIV infection. The patient was diagnosed with HIV-infection and treated with a combination of anti-retroviral agents and dapsone. Two years after the start of treatment the lesion had regressed.

Cutaneous Metastasis on the Face from the Cardiac Angiosarcoma / 대한피부과학회지

Angiosarcoma is a rare, aggressive vascular neoplasm of the endothelial cell origin. It is usually seen in male, elderly patients and generally has a poor prognosis due to its high potential for metastasis. They arise at various sites such as skin, soft tissue, heart and great vessels. However, the tumors have a predilection for skin and superficial soft tissue. Most angiosarcomas of the skin arise in the three clinical variant; primary angiosarcoma of the face and scalp in the elderly patients; following lymphedema, and post radiation or trauma. Although, this tumor tend to recur locally and metastasize to the viscera, especially in the lung, but cutaneous metastasis of angiosarcomas from the internal organ are uncommon. Herein, we report a patient with cutaneous metastasis from primary cardiac angiosarcoma in the right atrium.

Efficacy of Itraconazole Prophylaxis for Autologous Stem Cell Transplantation in Children with High-Risk Solid Tumors: A Prospective Double-Blind Randomized Study

PURPOSE: The risk of invasive fungal infection is greater for allogeneic hematopoietic stem cell transplantation (HSCT) than for autologous transplantation. Therefore, many transplantation centers use antifungal prophylaxis for allogeneic HSCT, however, there exists no standard guidelines or consensus regarding autologous HSCT. MATERIALS AND METHODS: A prospective double-blind randomized study was conducted in autologous HSCT recipients who were divided into prophylaxis and empirical treatment groups, and we investigated the efficacy of itraconazole prophylaxis in pediatric autologous HSCT. RESULTS: Total 87 autologous HSCT episodes in 55 children with high-risk solid tumors were studied. No invasive fungal infections occurred in either group. However, patients in the prophylaxis group had a significantly shorter duration of fever (p < 0.05) and received antibacterial treatment of shorter duration (p < 0.05) with fewer numbers of antibiotics (p < 0.05 for the use of second line antibiotics) than those in the empirical group. No significant additional adverse events were found with itraconazole prophylaxis. CONCLUSION: Although beneficial effects such as a shorter duration of fever and reduced need for antibiotic use were observed in the prophylaxis group, the results were not sufficient to draw a definite recommendation about the routine use of antifungal prophylaxis in pediatric autologous HSCT recipients with high-risk solid tumors (Trial registration: NCT00336531).

A Case of Renal Salt Wasting Syndrome Induced by Cisplatin for Chemotherapy / 대한신장학회지

Cisplatin is widely used for chemotherapy, but known to cause renal, auditory, hematologic, gastrointestinal, and neurologic toxicities. Hyponatremia after administration of cisplatin is related to renal tubular sodium excretion. A 71-year-old female was referred to our hospital for chemotherapy of laryngeal cancer. On admission, the patient's laboratory data were normal. The patient received for 3 days chemotherapy without complication, but presented mental confusion on the 4th hospital day. The laboratory findings were as follows; serum sodium was 118 mmol/L, urine sodium 163 mmol/L, serum osmolality 248 mmol/kg, and urine osmolality 594 mmol/kg. On physical exam, volume status was hypovolemic, so we supplied hypertonic and isotonic salines. On the 9th hospital day, she showed normal sodium concentration and clear consciousness. After chemotherapy, we should make differential diagnosis between SIADH (syndrome of inappropriate antidiuretic hormone) and renal salt wasting syndrome according to the physical examination. We report a case of renal salt wasting syndrome with severe mental change after chemotherapy using cisplatin.