Vitamin D deficiency is associated with increased risk of bacterial infections after kidney transplantation

BACKGROUND/AIMS: There may be an association between vitamin D levels and allograft outcomes in kidney transplant recipients (KTRs). However, few studies have been conducted to determine the association between vitamin D levels and post-transplant infections. This study investigated the impact of vitamin D deficiency on the risk of infection after kidney transplantation. METHODS: We measured 25-hydroxyvitamin D (25(OH)D) levels prior to kidney transplantation. Vitamin D deficiency was defined as a serum 25(OH)D level < 20 ng/mL. We examined the incidence of various post-transplant infections during follow-up period. We used Cox proportional hazards regression analysis to determine factors associated with increased risk of post-transplant infections during the follow-up period. RESULTS: A total of 164 KTRs were followed up for a mean of 24.8 ± 10.7 months. Among them, 135 patients (82.3%) had vitamin D deficiency. Patients with vitamin D deficiency had a significantly higher incidence of urinary tract infection (p = 0.027) and any bacterial infection (p = 0.010) compared to those without vitamin D deficiency. Vitamin D deficiency was not significantly associated with incidence of viral or fungal infections. Cox proportional hazards regression analysis revealed that vitamin D deficiency (hazard ratio, 11.07; 95% confidence interval, 1.46 to 84.03; p = 0.020) was independent risk factor for post-transplant bacterial infections. CONCLUSIONS: Pre-transplant vitamin D deficiency was a significant risk factor for bacterial infections after kidney transplantation. Further studies are needed on possible benefits of vitamin D supplementation for preventing post-transplant bacterial infection.

Vitamin D deficiency is associated with increased risk of bacterial infections after kidney transplantation

BACKGROUND/AIMS: There may be an association between vitamin D levels and allograft outcomes in kidney transplant recipients (KTRs). However, few studies have been conducted to determine the association between vitamin D levels and post-transplant infections. This study investigated the impact of vitamin D deficiency on the risk of infection after kidney transplantation. METHODS: We measured 25-hydroxyvitamin D (25(OH)D) levels prior to kidney transplantation. Vitamin D deficiency was defined as a serum 25(OH)D level < 20 ng/mL. We examined the incidence of various post-transplant infections during follow-up period. We used Cox proportional hazards regression analysis to determine factors associated with increased risk of post-transplant infections during the follow-up period. RESULTS: A total of 164 KTRs were followed up for a mean of 24.8 ± 10.7 months. Among them, 135 patients (82.3%) had vitamin D deficiency. Patients with vitamin D deficiency had a significantly higher incidence of urinary tract infection (p = 0.027) and any bacterial infection (p = 0.010) compared to those without vitamin D deficiency. Vitamin D deficiency was not significantly associated with incidence of viral or fungal infections. Cox proportional hazards regression analysis revealed that vitamin D deficiency (hazard ratio, 11.07; 95% confidence interval, 1.46 to 84.03; p = 0.020) was independent risk factor for post-transplant bacterial infections. CONCLUSIONS: Pre-transplant vitamin D deficiency was a significant risk factor for bacterial infections after kidney transplantation. Further studies are needed on possible benefits of vitamin D supplementation for preventing post-transplant bacterial infection.

Development of Kaposi sarcoma and hemophagocytic lymphohistiocytosis associated with human herpesvirus 8 in a renal transplant recipient

No abstract available.

Impact of dialysis modality on technique survival in end-stage renal disease patients

BACKGROUND/AIMS: This study analyzed the risk factors for technique survival in dialysis patients and compared technique survival rates between hemodialysis (HD) and peritoneal dialysis (PD) in a prospective cohort of Korean patients. METHODS: A total of 1,042 patients undergoing dialysis from September 2008 to June 2011 were analyzed. The dialysis modality was defined as that used 90 days after commencing dialysis. Technique survival was compared between the two dialysis modalities, and the predictive risk factors were evaluated. RESULTS: The dialysis modality was an independent risk factor predictive of technique survival. PD had a higher risk for technique failure than HD (hazard ratio [HR], 10.8; 95% confidence interval [CI], 1.9 to 62.0; p = 0.008) during a median follow-up of 11.0 months. In the PD group, a high body mass index (BMI) was an independent risk factor for technique failure (HR, 1.3; 95% CI, 1.0 to 1.8; p = 0.036). Peritonitis was the most common cause of PD technique failure. The difference in technique survival between PD and HD was more prominent in diabetic patients with a good nutritional status and in non-diabetic patients with a poor nutritional status. CONCLUSIONS: In a prospective cohort of Korean patients with end-stage renal disease, PD was associated with a higher risk of technique failure than HD. Diabetic patients with a good nutritional status and non-diabetic patients with a poor nutritional status, as well as patients with a higher BMI, had an inferior technique survival rate with PD compared to HD.

Duration of anuria predicts recovery of renal function after acute kidney injury requiring continuous renal replacement therapy

BACKGROUND/AIMS: Little is known regarding the incidence rate of and factors associated with developing chronic kidney disease after continuous renal replacement therapy (CRRT) in acute kidney injury (AKI) patients. We investigated renal outcomes and the factors associated with incomplete renal recovery in AKI patients who received CRRT. METHODS: Between January 2011 and November 2013, 408 patients received CRRT in our intensive care unit. Of them, patients who had normal renal function before AKI and were discharged without maintenance renal replacement therapy (RRT) were included in this study. We examined the incidence of incomplete renal recovery with an estimated glomerular filtration rate < 60 mL/min/1.73 m² and factors that increased the risk of incomplete renal recovery after AKI. RESULTS: In total, 56 AKI patients were discharged without further RRT and were followed for a mean of 8 months. Incomplete recovery of renal function was observed in 20 of the patients (35.7%). Multivariate analysis revealed old age and long duration of anuria as independent risk factors for incomplete renal recovery (odds ratio [OR], 1.231; 95% confidence interval [CI], 1.041 to 1.457; p = 0.015 and OR, 1.064; 95% CI, 1.001 to 1.131; p = 0.047, respectively). In a receiver operating characteristic curve analysis, a cut-off anuria duration of 24 hours could predict incomplete renal recovery after AKI with a sensitivity of 85.0% and a specificity of 66.7%. CONCLUSIONS: The renal outcome of severe AKI requiring CRRT was poor even in patients without further RRT. Long-term monitoring of renal function is needed, especially in severe AKI patients who are old and have a long duration of anuria.

Relationships between pathological patterns and vocal qualities estimated by acoustic parameters / 中国结合医学杂志

<p><b>OBJECTIVE</b>To examine whether vocal characteristics estimated by acoustic parameters were associated with phlegm, yin deficiency, or cold-heat patterns.</p><p><b>METHODS</b>A total of 75 college students (males:females = 53:22) aged 19-24 years were enrolled in this study. Each subject was asked to complete the phlegm pattern questionnaire (PPQ), yin deficiency questionnaire (YDQ) and cold-heat questionnaire (CHQ). For the acoustic analysis, each subject was asked to produce a sustained vowel sound (/a/) for 3 s to be used to calculate acoustic parameters. Then, habitual fundamental frequency (F0), jitter, shimmer, F0tremor, mean F0, standard deviation of F0, maximum F0, minimum F0, normalized noise energy, harmonic-to-noise ratio, signal-to-noise ratio, amplitude tremor, and power ratio were calculated using the Dr. Speech software. Finally, four hierarchical regression models with pattern questionnaire scores as dependent variables were formed to examine which factors among acoustic parameters, sex, and age were predictive of those pattern scores.</p><p><b>RESULTS</b>PPQ, YDQ, heat, and cold pattern scores all formed significant regression model equations and the adjusted R2 values were 0.281, 0.164, 0.156, and 0.170, respectively. There were aging effects in the PPQ and YDQ models (standardized β=0.199, 0.271, respectively). Vocal tremor-related F0 tremor and vocal ringing-related power ratio parameters were associated with PPQ and YDQ scores. Gender was directly predictive of PPQ and indirectly moderated the relationship between power ratio and YDQ score. Vocal pitch-related habitual F0 and mean F0 were associated with heat and cold scores. These results indicate that the vocal qualities of phlegm- and yin deficiency-susceptible subjects tend to be ringing and less tremorous, and those of heat- and cold-susceptible subjects tend to be high-pitched.</p><p><b>CONCLUSION</b>Our study results suggest that vocal characteristics estimated by acoustic parameters are partially predictive of phlegm, yin deficiency, heat, and cold patterns. In terms of phlegm and yin deficiency patterns, there were direct or moderating effects of sex and age.</p>

Development and validation of a Lao Juan questionnaire / 中国结合医学杂志

<p><b>OBJECTIVES</b>Lao Juan (LJ, ) is a syndrome described in Chinese medicine (CM) that manifests with fatigue, fever, spontaneous sweating, indigestion, work-induced pain, weakness of the limbs, and shortness of breath. The present study was conducted to examine the reliability and validity of a Lao Juan Questionnaire (LJQ).</p><p><b>METHODS</b>A total of 151 outpatients and 73 normal subjects were asked to complete the LJQ. Seventy-three normal subjects were additionally asked to complete the Chalder Fatigue Scale (CFS). Twelve clinicians determined whether the 151 outpatients exhibited LJ or not. The internal consistency and construct validity for the LJQ were estimated using data from the outpatient subjects. The CFS data were used to examine the concurrent validity of the LJQ. Total LJQ scores and the clinicians᾿diagnoses of the outpatients were used to perform receiver operating characteristics (ROC) curve analyses and to define an optimum cut-off score for the LJQ.</p><p><b>RESULTS</b>The 19-item LJQ had satisfactory internal consistency (α=0.828) and concurrent validity, with significant correlations between the LJQ and the CFS subscales. In the test of construct validity using principal component analysis, a total of six factors were extracted, and the overall variance explained by all factors was 59.5%. In ROC curve analyses, the sensitivity, specificity, and area under the curve were 76.0%, 59.2%, and 0.709, respectively. The optimum cut-off score was defined as six points.</p><p><b>CONCLUSIONS</b>Our results suggest that the LJQ is a reliable and valid instrument for evaluating LJ.</p>

Obstructive Fibrinous Tracheal Pseudomembrane Presented with Atelectasis / 대한구급학회지

Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare condition usually associated with endotracheal intubation. Airway obstruction caused by OFTP may occur after endotracheal tube extubation and can lead to severe respiratory distress. It is a rare but potentially fatal complication. In this report, we present a case of OFTP presented with atelectasis that caused dyspnea after extubation and was successfully treated by mechanical removal using a rigid bronchoscope.

Takotsubo Cardiomyopathy Caused by Pulmonary Tuberculosis: A Case Report / 결핵및호흡기질환

Takotsubo cardiomyopathy (TTC) is defined as a reversible, acute ventricular dysfunction without any evidence of coronary artery obstruction. There have been reports of TTC caused by emotional or physical stress, drug use, hormone imbalance, or medical conditions such as pulmonary disease, sepsis, and trauma, but a relationship between TTC and pulmonary tuberculosis has not previously been reported. From our knowledge, this is the first report of TTC caused by pulmonary tuberculosis.

Takotsubo Cardiomyopathy Caused by Pulmonary Tuberculosis: A Case Report / 결핵및호흡기질환

Takotsubo cardiomyopathy (TTC) is defined as a reversible, acute ventricular dysfunction without any evidence of coronary artery obstruction. There have been reports of TTC caused by emotional or physical stress, drug use, hormone imbalance, or medical conditions such as pulmonary disease, sepsis, and trauma, but a relationship between TTC and pulmonary tuberculosis has not previously been reported. From our knowledge, this is the first report of TTC caused by pulmonary tuberculosis.

Glucocorticoid Triggers an Attack of Periodic Hypokalemic Paralysis during Treatment for Diffuse Large B-cell Lymphoma / 대한내과학회지

Hypokalemic periodic paralysis is a rare disorder characterized by sudden onset of weakness and low serum potassium levels. We report a case provoked by combination chemotherapy including prednisolone. A 23-yr-man, diagnosed with diffuse large B-cell lymphoma, received chemotherapy. He developed significant weakness in upper and lower extremities during chemotherapy, and his serum potassium level was 1.7 mmol/L. Potassium replacement restored the weakness. Further workup revealed that prednisolone had provoked hypokalemic paralysis. As prednisolone triggered an attack of hypokalemic periodic paralysis, it should be administered with caution, particularly in patients with periodic paralysis.

Glucocorticoid Triggers an Attack of Periodic Hypokalemic Paralysis during Treatment for Diffuse Large B-cell Lymphoma / 대한내과학회지

Hypokalemic periodic paralysis is a rare disorder characterized by sudden onset of weakness and low serum potassium levels. We report a case provoked by combination chemotherapy including prednisolone. A 23-yr-man, diagnosed with diffuse large B-cell lymphoma, received chemotherapy. He developed significant weakness in upper and lower extremities during chemotherapy, and his serum potassium level was 1.7 mmol/L. Potassium replacement restored the weakness. Further workup revealed that prednisolone had provoked hypokalemic paralysis. As prednisolone triggered an attack of hypokalemic periodic paralysis, it should be administered with caution, particularly in patients with periodic paralysis.

Successful treatment of steroid resistant hypereosinophilic syndrome with low-dose CsA

No abstract available.

Relationship among the Myelography, MRI and EMG in Young Patients with Low Back Pain or Radiating Pain

PURPOSE: We wanted to evaluate the relationship among the myelography, magnetic resonance imaging (MRI), and electromyography (EMG) findings in young patients with low back pain, and we wanted to assess the significance of the spinal geometric measurements as well as type of disc herniation seen on MRI. MATERIALS AND METHODS: Forty-four young men with lower back pain were included, and they were all clinically suspected of suffering with lumbar disc herniation. All of them underwent myelography, MRI and EMG. We measured spinal geometry including the anteroposterior diameters of the central canal and thecal sac, the interlaminar distance, the width of the lateral recess and the thickness of the ligamentum flavum, and we evaluated for root deviation as well as disc herniation on the MRIs. We compared the types of disc herniation on MRI with the myelography and EMG findings. Also, we investigated the correlation of the spinal geometric measurements on MRI with the EMG and myelography findings. RESULTS: The types of disc herniation on MRI were not significantly related to the myelography (p = 0.298) and EMG findings (p = 0.372). The EMG findings were not related to either the myelography findings (p = 0.435) or the spinal geometric measurements (p > 0.05) on MRI. Nerve root compression that was noted on myelography was related to the thecal sac AP diameter (p = 0.016) and the width of the lateral recess (p = 0.011). There were no correlations between myelography and the findings of root deviation on MRI (p=0.052). CONCLUSION: MRI can play an excellent diagnostic role for young patients with radiculopathy or lower back pain. It could increase the diagnostic accuracy if it is used in conjunction with myelography and EMG. The narrowing of thecal sac AP diameter and the width of lateral recess rather than the type of disc herniation on MRI were well correlated with the myelography and EMG findings.

The Effect of Myocardial Infarction on the Reproductive Function in Adult Male Rats / 체질인류학회지

The present study was to investigate in more detail the changes of reproductive function in the male rat following myocardial infarction (MI). Ligation of the left coronary artery was performed in male Sprague-Dawley male rats at 60 days of age. Control rats were obtained sham-operated animals. MI rats were sacrificed at 1, 3, 5, 7, 14, and 30 day after ligation of left anterior descending coronary artery. Control rats were sacrificed on 30 day after thoracotomy. Myocardial infarct size was assessed by planimetry and perimetry. Testes of rats were fixed by whole body perfusion using a fixative containing 2.5% glutaraldehyde in cacodylate buffer, processed and embedded in Epon-araldite. Using 1 micro sections stained with methylene blue-azure II, qualitative and quantitative (stereological) morphological studies were performed. Testosterone levels in the incubation medium of luteinizing hormone-stimulated (100 ng/mL) testosterone secretion per testis in vitro, and in serum were determined by radioimmunoassay. Sperm production was measured by routine technique. Mean infarct size was 29.5~33.5% of the left ventricle after coronary occlusion in experimental groups. No changes were observed in testis volume, absolute volume of Leydig cell, Leydig cell size, and number of Leydig cell per testis in MI rats compared to sham-operated animals. Serum testosterone, LH-stimulated testicular testosterone production, and daily sperm production in MI rats were not significantly different (P>0.05) from sham-operated animals. These results demonstrate that under the experimental conditions employed here, experimental chronic myocardial infarction does not exert adverse effects on the reproductive function of male rats.

The Relation between Radiologic and Electromyographic Findings in Patients with Low Back Pain

OBJECTIVE: To determine the relations of spinal measurements on magnetic resonance imaging (MRI), myelography and electromyography (EMG) in patients with low back pain. METHOD: We investigated forty four patients who were underwent both imaging and electrodiagnostic evaluation. Spinal geometric measurements in axial MRI included anteroposterior (AP) diameters of canal and thecal sac, interlaminar distance, width of lateral recess, thickness of ligamentum flavum, and the findings of a root deviation. This study investigated: 1) correlation of MRI disc herniation types with EMG and myelogram findings, 2) correlation of EMG findings with axial MRI spinal measurements and myelogram findings, 3) correlation of myelogram with axial MRI spinal measurements. RESULTS: The MRI disc herniation types did not relate to EMG and myelogram findings. Findings of the root compression on myelogram related to the width of lateral recess and thecal sac AP diameter only (p<0.05). There were nonparametric correlations between myelogram findings and the findings of root deviation on MRI (p<0.05). CONCLUSION: There were little correlations between EMG findings and other imaging studies. In addition, we suggest not only the disc herniation type, but also the width of lateral recess and thecal sac AP diameter is helpful in interpreting the axial spinal MRI.

Effects of Luteinizing and Thyroid Hormones on the Aged Leydig Cells in Brown Norway Rats / 체질인류학회지

ABSTRACT: The present study was designed to investigate the possibility of restoring the testicular steroidogenic ability of the aged Brown Norway rats by administering luteinizing hormone (LH) and thyroxine (Thy). Rats of 3, 6, 12 months (M) of age (n = 8 per group) and four groups of 18 month old rats (n = 8 per group) were used. Eighteen month old rats were implanted subdermally with Alzet mini osmotic pumps containing saline (control), luteinizing hormone (LH, 24 microgram/day), thyroxine (Thy, 5 microgram/day) and LH and Thy (LH +Thy, 24 microgramday and 5 microgram/day), respectively for four weeks (i.e testing was done at 19 months). The results showed that the testis volume was unchanged among all treatment groups. The number of Leydig cell per testis was not significantly different among all treatment groups. The average volume of a Leydig cell was significantly decreased at 12 months, and a further reduction was observed at 19 months (saline-treated); values for 19 month LH-and-LH +Thy-treated rats were not significantly lower than those at 3 and 6 months of age. Testosterone secretory capacity per testis and per Leydig cell in vitro were significantly reduced concomitantly with age advancement from 6 to 19 months (saline-treated) of age. These values of LH-and Thy-treated 19 month old rats were similar to those at 12 months. LH +Thy-treated rats were equally capable to 3 and 6 month old rats in producing testicular testosterone in vitro in response to LH. Serum testosterone was unchanged from 3 M to 12 M rats but was reduced in 19M control rats. Both LH and Thy significantly raised these values above the 19M control levels, but they were still lower than the 3 M through 12 M levels. Additionally, LH +Thy significantly raised the serum testosterone levels to those of 12M rats, but these values were significantly lower than those of 3 M and 6 M rats. In summary, the present study demonstrated that the exogenous supplementation of LH and Thy was effective in restoring the steroidogenic potential of the aged Leydig cells; the most effective treatment was LH +Thy, which upgraded the capacity of aged testes to those of 3 and 6 months.

Effect of Lumbar Extensor Strengthening in Chronic Low Back Pain Patients

OBJECTIVE: To evaluate the effects of strengthening exercise for isolated lumbar extensor muscles on chronic low back pain patients. METHOD: 28 patients with chronic low back pain in back school program participated in this study. Initially, isometric lumbar extensor strength, 10 point of Visual analog scale (VAS) and questionnaires related to self-experienced symptoms and daily activity (ADL) were checked. Isometric lumbar extensor strength test and strengthening exercise were performed with MedXTM lumbar extensor machine, which was designed to stabilize the pelvis. After 8 weeks of training program, isometric lumbar extensor strength & other pain related variables were checked again in the same way. RESULTS: The results were as follows: 1) After 8 weeks of lumbar extensor strengthening program, isometric lumbar extensor strength was increased at all the measured points significantly (p<0.01). 2) VAS and ADL were improved from 6.7 to 3.7, and from 6.9 to 9.1 respectively (p<0.05). CONCLUSION: 8 weeks of lumbar extensor strengthening program with pelvic stabilization was effective therapeutic tools for patients with chronic low back pain.

Assessments of Activities of Daily Living for Disabled Persons in Some Rural Communities

OBJECTIVE: Aims of this study are to assess the activities of daily living (ADL) for disabled persons in some rural communities using an appropriately developed ADL scale and to analyse the relationship between severity of impairment and ADL score. METHOD: ADLs of 98 disabled persons in two myeons of Kyunggido were assessed from May 1996 to August 1997. The newly developed ADL index composed of eight basic ADL (B-ADL) and two instrumental ADL (I-ADL) parameters were used. Impairment defined by the National Reparation Law was divided into a severely disabled group, grades 1 to 6 and a mildly disabled group, graded 7 to 14. Correlations between the impairment grade of each body part and the assessed ADL score were studied. RESULTS: 1) The most dependent ADL item of ten ADL parameters was performance in the public office (37.8%) and, the most independent ADL item was feeding (98.0%). 2) With severe impairment of the upper or lower limb, all ADL scores except for feeding were significantly low (p<0.05). In addition, with severe hearing impairment, scores of performance in public office were accessed low (p<0.05). 3)With severe lower limb impairment, average scores of I-ADL and B-ADL were low (p<0.05). 4) With severe language impairment, the average I-ADL score was also low (p<0.05). CONCLUSION: The task of performance in the public office was the most difficult ADL item for disabled persons. All ADL parameters except feeding were affected for disabled persons with lower or upper limb impairment. We think this pilot study may be used to develop more appropriate ADL scales for community based rehabilitation in the future.

Effect of Chronic exposure to Low-Levels of n-Hexane on Peripheral Nervous System / 대한산업의학회지

OBJECTIVES: The effect of chronic exposure to low levels of n-hexane on peripheral nervous system and the relationship between duration of employment and impairment of peripheral nervous system was studied. METHODS: In 21 workers at two shoe - maker factories and 21 unexposed controls, measurement of exposure of solvents, symptom Questionnaire, physical examination and electrophysiological study were conducted. RESULTS: Mean ages of study subjects in the exposed and the unexposed were 39.9 and 40.1 years old. Mean durations of employment were 15.1 and 10.0 years, respectively. Mean concentraions of urinary 2,5-HD were 2.23 mg/kg creatinine, 0.23 mg/kg creatinine, respectively. Mean concentration of solvents in air were 21.1 ppm of n-hexane, 72.2 rpm of toluene and 0.5 ppm of MEK. There were no differences in the prevalence of subjective symptoms and abnormal neurological signs between the exposed and the unexposed. But vibration extinction time(VAT) of the exposed(8.8 second) was shorter than that of the unexposed(11.9 second)(p < 0.05). Mean values of electrophysiological studies(EPS) of the two groups were within normal limit. However, mean conduction velocity of median motor nerve and median F wave(MMNCV and MFCV), mean amplitude of median sensory action potential(MSAP) were decreased in the exposed(p < 0.05). Moreover, the rate of abnormal finding more than one in sensory nerves wart increased in the exposed than those in the unexposed(p,0.05). Correlation coefficients between duration of employment and mean conduction velocity of median sensory nerve (MSNCV) and between duration of employment and MFCV were -0.57 -0.43, respectively(p < 0.05). CONCLUSIONS: These results showed that chronic (mean 15 years) low level(mean 23 ppm) exposure to n-hexane cause subclinical impairment of peripheral nervous system. These results also suggest that the longer duration of employment, the shorter values of EPB and VAT.