Promotion of Platelet Production by Co-Transplantation of Mesenchymal Stem Cells in Bone Marrow Transplantation

BACKGROUND@#Therapeutic strategies that can promote platelet production are in demand to enhance clinical outcomes of bone marrow transplantation (BMT). Our research group has studied human tonsil-derived mesenchymal stem cells (TMSCs) and their effectiveness in promoting bone marrow (BM) engraftment. Here, we analyzed the effects of T-MSCs on platelet production and hemostasis. @*METHODS@#Donor BM cells (BMCs) were isolated from C57BL/6 mice and transplanted with or without T-MSCs to BALB/c recipient mice. Mice were sacrificed and blood cells were counted using an Auto Hematology Analyzer. Femur sections were stained with CD41 antibody to analyze megakaryocytes in the BM. Growth factor secretion from MSCs was analyzed using the Quantibody Array. Effects of T-MSC conditioned medium (CM) on megakaryopoiesis were investigated using the MegaCult assay. In a mouse model of BMT, T-MSC CM was injected with or without anti-placental growth factor (a-PlGF) blocking antibody, and blood cell numbers and coagulation were analyzed. @*RESULTS@#T-MSC co-transplantation increased percent survival of BMT mice. Platelet numbers were significantly lower in the BMC-only group, whereas T-MSC co-transplantation restored circulating platelets to levels similar to those of the control group. Significantly reduced numbers of CD41 ? megakaryocytes in Bu-Cy and BMC groups were increased by T-MSC co-transplantation. PlGF secretion from T-MSCs were detected and enhanced megakaryopoiesis, platelet production, and coagulation by T-MCS CM were disrupted in the presence of the a-PlGF blocking antibody. @*CONCLUSION@#We demonstrated the effectiveness of T-MSC co-transplantation in promoting platelet production and coagulation after BMT. These findings highlight the potential therapeutic relevance of T-MSCs for preventing thrombocytopenia after BMT.

Incidence and Analysis of Adverse Transfusion Reactions at a Single Children’s Hospital / 대한수혈학회지

Adverse transfusion reactions (ATRs) are unexpected reactions to transfusion. This study examined the frequency, types of ATRs, and related blood products retrospectively in pediatric patients with less information than in adult patients. Four hundred and forty transfusions were performed for two months at a children’s hospital: 247 units of red blood cell (RBC) products, 142 units of platelet products, and 41 units of fresh frozen plasma (FFP) were used.Five adverse reactions occurred in five patients, three cases were allergic reactions, and two were febrile nonhemolytic reactions. The frequency was 1.13%, and apheresis platelets and leukocyte-reduced RBC were transfused. Two patients’ ATRs were found in the previous transfusions, and ATRs were repeated in subsequent transfusions in one patient. One of the ATRs was not reported to the blood bank and was then discovered during the study. Because pediatric patients may have limitations in recognizing or expressing their symptoms compared to adults, medical staff rely solely on vital signs and laboratory results rather than symptoms, causing difficulty in noticing ATRs. Information on ATRs and education on appropriate blood products will improve awareness of ATRs and blood management among medical staff at transfusion sites and blood banks.

A Study of Otologic Symptoms and Prognosis in Patients With Ramsay Hunt Syndrome and Bell’s Palsy / 대한이비인후과학회지

Background and Objectives@#Although several studies have compared the characteristics of Ramsay Hunt syndrome (RHS) with Bell’s palsy (BP), the differences in comorbid symptoms and prognosis according to symptoms have not been determined. This study therefore evaluated the differences in otologic symptoms and prognosis between patients with these two conditions.Subjects and Method The medical records of 118 patients with RHS and 215 patients with BP were retrospectively reviewed. Factors compared in these two groups included otologic symptoms, general health condition, electroneurography (ENoG) and House-Brackmann grades. @*Results@#Age, sex, body mass index, lipid profiles, ENoG, rate of diabetes, and side of palsy did not differ significantly between patients with RHS and BP (p>0.05). The rates of hearing disturbance, tinnitus, vertigo, and postauricular pain were significantly higher in RHS (p0.05). Additionally, in patients with facial paralysis, diabetes was associated with hearing disturbance and vertigo symptoms and dyslipidemia was associated with postauricular pain (p<0.05 each). @*Conclusion@#Otologic symptoms were more common in RHS than in BP. However, the prognosis of RHS and BP were not related to otologic symptoms. In patients with facial palsy hearing disturbance and vertigo were associated with diabetes and hypertension. Also, dyslipidemia was associated with post auricular pain.

Comparison between Screening Cells Including Dia and Mia Antigen for Unexpected Antibody Screening / 대한수혈학회지

The Dia and Mia antigens have been detected in Koreans with a frequency of 6.4∼14.5% and 0.9%, respectively. This study evaluated the effectiveness of different screening cells using the cells with Diaand Mia antigens for unexpected antibody screening. An unexpected antibody-screening test was performed separately using different screening cells, including the Dia antigen (Panel D) and Mia antigen (Panel M). A total of 2,077 specimens from 1,847 patients were collected, among which 49 (2.32%) and 43 (2.08%) were positive using Panel D and Panel M, respectively. Twenty-seven patients were positive with both panels, 2012 were negative with both panels, and thirty-eight patients showed a discordant result. The suspected anti-Diaand anti-Mia were detected in 4 (0.19%) and 5 (0.24%) patients, respectively. Therefore, the frequency of anti-Dia and anti-Mia antibodies in this study may be helpful for selecting unexpected antibody screening reagents.

Effectiveness and Safety of Two Different Formulations of Oral Propranolol Treatment for 375 Cases of Infantile Hemangioma: A Korean Single-center Experience / 대한피부과학회지

Background@#Oral propranolol has recently been introduced as a successful treatment for infantile hemangioma (IH).Though, there are limited reports on this treatment including large number of Korean patients with IH covering a long-term powder and solution formulation period. @*Objective@#We investigated the effectiveness and side effects of two different formulations of oral propranolol treatment in patients with IH at a Korean tertiary university hospital. @*Methods@#From June 2011 to October 2019, 375 patients were treated with powder- or solution-type oral propranolol starting at 1 mg/kg/day and increasing up to 3 mg/kg/day. Drug effectiveness was evaluated on four scales through sequential photographs by two dermatologists. Side effects were recorded on a medical chart. @*Results@#Overall, the mean improvement scale was 2.61±0.73 at 3 months after treatment initiation. The scale was higher for solution-type than for powder-type oral propranolol at the 3-month follow-up (2.71±0.79 vs. 2.54±0.67, p＜0.05). The patients’ mean duration of treatment was 8.56±5.85 months, which was shorter for solution-type than for powder-type oral propranolol (6.0 vs. 10.69 months, p＜0.05). Among the total number of patients, 22 reported mild side effects, including loose stools and noticeable sleep disturbance, and few serious side effects such as grunting, while two patients required medical intervention. @*Conclusion@#The patients in our study were effectively treated for IH with oral propranolol without significant side effects and had a shorter treatment duration with solution-type oral propranolol than with powder-type oral propranolol.

Application of Deep Convolutional Neural Networks in the Diagnosis of Subcutaneous Masses Using Ultrasonography: A Pilot Study / 대한피부과학회지

Background@#Ultrasonography is an effective noninvasive imaging modality for the diagnosis of subcutaneous masses. To date, few studies have reported skin ultrasonography using deep convolutional neural networks (DCNNs).We investigated the accuracy of DCNNs for the diagnosis of epidermal cysts, lipomas, and other subcutaneous masses. @*Objective@#The purpose of this study was to evaluate whether DCNNs could diagnose subcutaneous masses with ultrasonographic images at level of competence comparable to dermatologists. @*Methods@#We created a dataset of 1,361 skin ultrasonography images obtained from 202 patients diagnosed with epidermal cysts, lipomas, and other subcutaneous masses, to train the DCNNs using ResNet18. Performance was compared with another set of 93 ultrasonographic images (24 epidermal cysts, 25 lipomas, and 44 other subcutaneous masses) from open-access articles. @*Results@#The DCNNs yielded 87.10% classification accuracy and 86.10% F1-scores. The area under the curve, sensitivity, and specificity were 0.92 (95% confidence interval [CI] 0.86∼0.98), 75.00%, and 98.55% for epidermal cysts; 0.93 (95% CI 0.88∼0.98), 80.00%, and 94.12% for lipomas; and 0.97 (95% CI 0.93∼1.00), 97.73%, and 85.71% for other subcutaneous masses, respectively. Analysis using gradient-weighted class activation mapping revealed that the DCNNs could detect specific ultrasonographic findings of epidermal cysts and lipomas. @*Conclusion@#We propose that DCNNs combined with ultrasonography may aid in the diagnosis of subcutaneous masses in outpatient settings.

Transfusion and Plasmapheresis in Heart and Lung Transplantation in Korea / 대한수혈학회지

To increase the success rate of heart and lung transplantation, appropriate transfusion and desensitization treatment should be performed. In each hospital, transfusion should be performed according to the patient and hospital situation and monitored to ensure that an appropriate amount of transfusion is achieved is necessary. If HLA desensitization treatment is performed using plasmapheresis and immunosuppressants, the incidence of rejection and complications after transplantation can be reduced. For desensitization treatment that considers individual patient characteristics, close cooperation between clinical medical staff, blood bank personnel, and medical staff will be required.

Clinical Importance and the Prevalence of Kell Group Antigen in Korea according to Ethnicity / 대한수혈학회지

The anti-K antibody has a role in transfusion reactions or hemolytic disease of the fetus and newborns. The K antigen is rarely expressed in Koreans. On the other hand, the distribution of blood group antigens has changed in recent years owing to the increased number of immigrants. This study examined the prevalence of the Kell group antigens according to their parents’ birth region. In this study, 4% of participants whose parents were born in America, Europe, South Asia, and other countries expressed the K antigen. No participants whose parents were born in Korea or East Asia expressed the K antigen. The frequency of the anti-K is expected to increase because of blood donors with the K antigen. Therefore, it is necessary to consider the K antigen frequency and anti-K in transfusions and pregnancy cases in Korea.

Red Ginseng Acidic Polysaccharides Promote the Expression of Acne-Related Inflammatory Biomarkers in Lipopolysaccharide-Treated Sebocytes and Outer Root Sheath Cells and Cutibacterium acnes-Injected Mice

Background@#Although ginseng has beneficial effects largely related to their constituent ginsenosides, pharmacological effects of non-ginsenosides have been reported. Acidic polysaccharides of red ginseng (RGAP) are among the non-ginsenoside constituents that have characterized antioxidant properties. @*Objective@#We investigated the impact of RGAP on sebocytes and outer root sheath (ORS) cells treated with lipopolysaccharide (LPS) and in mice with Cutibacterium acnes (C. acnes)-induced inflammatory nodules. @*Methods@#Sebocytes and ORS cells were cultured and treated with either 0.1% dimethyl sulfoxide, 5 μg/ml LPS, 50 μg/ml RGAP or 5 μg/ml LPS+50 μg/ml RGAP for 6 and 24 hours.Real-time polymerase chain reaction, ELISA, Western blot analysis, and immunofluorescence staining were among the methods used to detect and quantify inflammatory cytokine production. Mice infected with C. acnes were treated with 2 weeks of RGAP provided in drinking water followed by immunohistochemical evaluation of inflammatory nodules. @*Results@#Administration of RGAP to LPS-treated sebocytes and ORS cell cultures resulted in increased expression of inflammatory cytokines like interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor-α, toll-like receptor 2, p-c-jun, p-JNK and p-iKB (p＜0.05). Administration of RGAP also resulted in increased expression of LL37 in LPS-treated sebocytes and ORS cells, and increased production of sebum in LPS-treated sebocytes (p＜0.05). RGAP also promoted increased expression of inflammatory biomarkers in C. acnes-associated inflammatory nodules in mice (p＜0.05). @*Conclusion@#RGAP may exacerbate inflammatory pathology associated with acne vulgaris. Ginseng supplements may be contraindicated in patients diagnosed with inflammatory acne.

Participants’ Satisfaction with the Atopic Dermatitis Education Program: Assessing the Impact of Each Content Using Structural Equation Modeling

Background@#Only a few studies have tried to assess factors relevant to the satisfaction of the participants in atopic dermatitis (AD) educational programs. More systematic modeling of this issue is needed. @*Objective@#To examine the benefit of a conjoint educational program for AD on patients and caregivers in a clinical setting. @*Methods@#In a half-day educational program called “AD school”, 831 people (493 patients and 338 family members) participated for 8 years. Various educational and entertaining programs were provided. The on-site survey was administered to measure participants’ satisfaction and perception of the benefit. We applied structural equation modeling to identify the relations among satisfaction and perception. @*Results@#A total of 209 family survey data was obtained and analyzed. The survey items were grouped into four categories. The categories were classified as individual education, group education, fun activity, and overall satisfaction (fun, benefit, intention to re-join and recommend to others). According to the model that we built, comprehensive group education was demonstrated to be the most relevant factor affecting overall satisfaction. @*Conclusion@#Our holistic approach would allow dermatologists to improve the efficacy of the conjoint educational program for AD.

Effectiveness and Safety of Two Different Formulations of Oral Propranolol Treatment for 375 Cases of Infantile Hemangioma: A Korean Single-center Experience / 대한피부과학회지

Background@#Oral propranolol has recently been introduced as a successful treatment for infantile hemangioma (IH).Though, there are limited reports on this treatment including large number of Korean patients with IH covering a long-term powder and solution formulation period. @*Objective@#We investigated the effectiveness and side effects of two different formulations of oral propranolol treatment in patients with IH at a Korean tertiary university hospital. @*Methods@#From June 2011 to October 2019, 375 patients were treated with powder- or solution-type oral propranolol starting at 1 mg/kg/day and increasing up to 3 mg/kg/day. Drug effectiveness was evaluated on four scales through sequential photographs by two dermatologists. Side effects were recorded on a medical chart. @*Results@#Overall, the mean improvement scale was 2.61±0.73 at 3 months after treatment initiation. The scale was higher for solution-type than for powder-type oral propranolol at the 3-month follow-up (2.71±0.79 vs. 2.54±0.67, p＜0.05). The patients’ mean duration of treatment was 8.56±5.85 months, which was shorter for solution-type than for powder-type oral propranolol (6.0 vs. 10.69 months, p＜0.05). Among the total number of patients, 22 reported mild side effects, including loose stools and noticeable sleep disturbance, and few serious side effects such as grunting, while two patients required medical intervention. @*Conclusion@#The patients in our study were effectively treated for IH with oral propranolol without significant side effects and had a shorter treatment duration with solution-type oral propranolol than with powder-type oral propranolol.

Application of Deep Convolutional Neural Networks in the Diagnosis of Subcutaneous Masses Using Ultrasonography: A Pilot Study / 대한피부과학회지

Background@#Ultrasonography is an effective noninvasive imaging modality for the diagnosis of subcutaneous masses. To date, few studies have reported skin ultrasonography using deep convolutional neural networks (DCNNs).We investigated the accuracy of DCNNs for the diagnosis of epidermal cysts, lipomas, and other subcutaneous masses. @*Objective@#The purpose of this study was to evaluate whether DCNNs could diagnose subcutaneous masses with ultrasonographic images at level of competence comparable to dermatologists. @*Methods@#We created a dataset of 1,361 skin ultrasonography images obtained from 202 patients diagnosed with epidermal cysts, lipomas, and other subcutaneous masses, to train the DCNNs using ResNet18. Performance was compared with another set of 93 ultrasonographic images (24 epidermal cysts, 25 lipomas, and 44 other subcutaneous masses) from open-access articles. @*Results@#The DCNNs yielded 87.10% classification accuracy and 86.10% F1-scores. The area under the curve, sensitivity, and specificity were 0.92 (95% confidence interval [CI] 0.86∼0.98), 75.00%, and 98.55% for epidermal cysts; 0.93 (95% CI 0.88∼0.98), 80.00%, and 94.12% for lipomas; and 0.97 (95% CI 0.93∼1.00), 97.73%, and 85.71% for other subcutaneous masses, respectively. Analysis using gradient-weighted class activation mapping revealed that the DCNNs could detect specific ultrasonographic findings of epidermal cysts and lipomas. @*Conclusion@#We propose that DCNNs combined with ultrasonography may aid in the diagnosis of subcutaneous masses in outpatient settings.

Transfusion and Plasmapheresis in Heart and Lung Transplantation in Korea / 대한수혈학회지

To increase the success rate of heart and lung transplantation, appropriate transfusion and desensitization treatment should be performed. In each hospital, transfusion should be performed according to the patient and hospital situation and monitored to ensure that an appropriate amount of transfusion is achieved is necessary. If HLA desensitization treatment is performed using plasmapheresis and immunosuppressants, the incidence of rejection and complications after transplantation can be reduced. For desensitization treatment that considers individual patient characteristics, close cooperation between clinical medical staff, blood bank personnel, and medical staff will be required.

Clinical Importance and the Prevalence of Kell Group Antigen in Korea according to Ethnicity / 대한수혈학회지

The anti-K antibody has a role in transfusion reactions or hemolytic disease of the fetus and newborns. The K antigen is rarely expressed in Koreans. On the other hand, the distribution of blood group antigens has changed in recent years owing to the increased number of immigrants. This study examined the prevalence of the Kell group antigens according to their parents’ birth region. In this study, 4% of participants whose parents were born in America, Europe, South Asia, and other countries expressed the K antigen. No participants whose parents were born in Korea or East Asia expressed the K antigen. The frequency of the anti-K is expected to increase because of blood donors with the K antigen. Therefore, it is necessary to consider the K antigen frequency and anti-K in transfusions and pregnancy cases in Korea.

Red Ginseng Acidic Polysaccharides Promote the Expression of Acne-Related Inflammatory Biomarkers in Lipopolysaccharide-Treated Sebocytes and Outer Root Sheath Cells and Cutibacterium acnes-Injected Mice

Background@#Although ginseng has beneficial effects largely related to their constituent ginsenosides, pharmacological effects of non-ginsenosides have been reported. Acidic polysaccharides of red ginseng (RGAP) are among the non-ginsenoside constituents that have characterized antioxidant properties. @*Objective@#We investigated the impact of RGAP on sebocytes and outer root sheath (ORS) cells treated with lipopolysaccharide (LPS) and in mice with Cutibacterium acnes (C. acnes)-induced inflammatory nodules. @*Methods@#Sebocytes and ORS cells were cultured and treated with either 0.1% dimethyl sulfoxide, 5 μg/ml LPS, 50 μg/ml RGAP or 5 μg/ml LPS+50 μg/ml RGAP for 6 and 24 hours.Real-time polymerase chain reaction, ELISA, Western blot analysis, and immunofluorescence staining were among the methods used to detect and quantify inflammatory cytokine production. Mice infected with C. acnes were treated with 2 weeks of RGAP provided in drinking water followed by immunohistochemical evaluation of inflammatory nodules. @*Results@#Administration of RGAP to LPS-treated sebocytes and ORS cell cultures resulted in increased expression of inflammatory cytokines like interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor-α, toll-like receptor 2, p-c-jun, p-JNK and p-iKB (p＜0.05). Administration of RGAP also resulted in increased expression of LL37 in LPS-treated sebocytes and ORS cells, and increased production of sebum in LPS-treated sebocytes (p＜0.05). RGAP also promoted increased expression of inflammatory biomarkers in C. acnes-associated inflammatory nodules in mice (p＜0.05). @*Conclusion@#RGAP may exacerbate inflammatory pathology associated with acne vulgaris. Ginseng supplements may be contraindicated in patients diagnosed with inflammatory acne.

Participants’ Satisfaction with the Atopic Dermatitis Education Program: Assessing the Impact of Each Content Using Structural Equation Modeling

Background@#Only a few studies have tried to assess factors relevant to the satisfaction of the participants in atopic dermatitis (AD) educational programs. More systematic modeling of this issue is needed. @*Objective@#To examine the benefit of a conjoint educational program for AD on patients and caregivers in a clinical setting. @*Methods@#In a half-day educational program called “AD school”, 831 people (493 patients and 338 family members) participated for 8 years. Various educational and entertaining programs were provided. The on-site survey was administered to measure participants’ satisfaction and perception of the benefit. We applied structural equation modeling to identify the relations among satisfaction and perception. @*Results@#A total of 209 family survey data was obtained and analyzed. The survey items were grouped into four categories. The categories were classified as individual education, group education, fun activity, and overall satisfaction (fun, benefit, intention to re-join and recommend to others). According to the model that we built, comprehensive group education was demonstrated to be the most relevant factor affecting overall satisfaction. @*Conclusion@#Our holistic approach would allow dermatologists to improve the efficacy of the conjoint educational program for AD.

A Case of Cytophagic Histiocytic Panniculitis Associated with Hemophagocytic Lymphohistiocytosis / 대한피부과학회지

Cytophagic histiocytic panniculitis (CHP) is a rare form of panniculitis, presenting lymphohistiocytic infiltration within subcutaneous fat tissue with phagocytic histiocytes. Associated systemic symptoms includes fever, hepatosplenomegaly, lymphadenopathy, serositis, pancytopenia, hepatic abnormalities, hypertriglyceridemia, and coagulopathy, which are the features of hemophagocytic lymphohistiocytosis (HLH). The patients of CHP associated with HLH may have nonfatal acute/intermittent, or rapidly fatal clinical courses, so the prompt and accurate diagnosis with immunosuppressive treatments are significant.

Platelet Inventory Management Program: Development and Practical Experience

Background@#Patients with ongoing or expected bleeding require platelet (PLT) transfusions; however, owing to the testing required after a blood donation, manufacturing PLT products may take 1.5–2.0 days after a request is made. This supply-demand mismatch leads clinicians to retain spare PLTs for transfusions, leading to increased PLT discard rates. We developed a PLT inventory management program to supply PLTs more efficiently to patients requiring PLT transfusions within the expiration date, while reducing PLT discard rates. @*Methods@#PLT concentrates (58,863 and 58,357 units) and apheresis products (7,905 and 8,441 units) were analyzed from May 2015 to November 2017 and from December 2017 to January 2020, respectively. We developed a program to manage total PLT inventories and prospective PLT transfusion patients based on blood type, blood product, and remaining period of efficacy; the program facilitates PLT preparation transfer to non-designated patients within the remaining period of efficacy. @*Results@#The overall PLT concentrate discard rate was 3,254 (2.78%): 1,811 (3.07%) units before and 1,443 units (2.41%) after program application (P < 0.001). The discard rate owing to expiration was reduced from 69 units (3.81%) before to two units (0.14%) after program application (P < 0.001). @*Conclusions@#This program can guide the allocation of PLT preparations based on the remaining period of efficacy, enabling PLT products to be used before their expiration date and reducing PLT product discard rate.

Analysis of Influencing Factors on the Outpatient Prescription of Antipsychotic Drugs in the Elderly Patients

Background@#Most antipsychotic drugs studies have been mainly conducted on side effects, randomized clinical trials, utilization rates, and trends. But there have been few studies on the influencing factors in elderly patients. The purpose of this study was to analyze the influencing factors on the outpatient prescription of antipsychotic drugs in the elderly patients. @*Methods@#Active ingredients of antipsychotic drugs in Korea were selected according to the Korean Pharmaceutical Information Center (KPIC)’s classification. Data source was Korean Health Insurance Review and Assessment Service (HIRA) claims data in 2020 and target patient group was the elderly patient group. We extracted patients who have been prescribed one or more antipsychotic drugs and visited only one medical institution. Data were analyzed using descriptive statistics, chi-square, t-test, negative binomial regression. @*Results@#A number of outpatients were 245,197 and prescriptions were 1,379,092. Most characteristics of patients were 75-85 year’s old, female, health insurance type, no disease (dementia, schizophrenia), atypical drugs, cci score (>2) and characteristics of medical institution were neurology in specialty, rural region, general hospitals. Results of regression showed that patient’s characteristics and medical center characteristics had significant effect on the outpatient prescription of antipsychotic drugs in the elderly patients. @*Conclusion@#This study suggests that national policy of antipsychotic drugs in the elderly patients, with the consideration of the patients’ and medical institutions’ characteristics, is needed.

Experience in Establishing Department of Transfusion Management / 대한수혈학회지

The blood management act was revised on December 4, 2020, to enhance transfusion management and has been established in accordance with the department of transfusion management in the medical institution. The department of transfusion management is involved in education related to transfusion, transfusion monitoring, and ward rounding. The department of transfusion management is essential for promoting the stability and safety of transfusions. This paper aims to help the department of transfusion management operation by sharing the experience of the department of transfusion management.