Structural insight into crystal structure of helicase domain of DDX53.

DEAD box helicase proteins are a family of RNA helicases that participate in various RNA metabolisms such as RNA unwinding, RNA processing, and RNPase activities. A particular DEAD box protein, the DDX53 protein, is primarily expressed in cancer cells and plays a crucial role in tumorigenesis. Numerous studies have revealed that DDX53 interacts with various microRNA and Histone deacetylases. However, its molecular structure and the detailed binding interaction between DDX53 and microRNA or HDAC is still unclear. In this study, we used X-ray crystallography to investigate the 3D structure of the hlicase C-terminal domain of DDX53, and successfully determined its crystal structure at a resolution of 1.97 Å. Subsequently, a functional analysis of RNA was conducted by examining the binding properties thereof with DDX53 by transmission electron microscopy and computing-based molecular docking simulation. The defined 3D model of DDX53 not only provides a structural basis for the fundamental understanding of DDX53 but is also expected to contribute to the field of anti-cancer drug discovery such as structure-based drug discovery and computer-aided drug design.

The living donor evaluation as a life-saving event.

BACKGROUND: As a population, living kidney donors have a longer life expectancy than the general population. This is generally thought to be an artifact of selection, as only healthy individuals are allowed to donate, and the operative mortality and risk of subsequent renal failure are very low. However, there may also be an additional benefit to the process, as the donor evaluation may uncover an early occult cancer or a potentially serious medical problem. While these problems may preclude donation, they may be lifesaving, as they are likely to be diagnosed and treated before the donor develops symptoms. PATIENTS AND METHODS: We looked at the incidence of occult cancer and other previously undiagnosed medical problems including renal disease, diabetes, hypertension, cardiac disease, and hepatitis C, in individuals volunteering to become a kidney donor at our center who proceeded with the evaluation between January 1, 1996 and May 31, 2011. RESULTS: Of 4088 potential donors, 19 (.46%) were discovered to have an unsuspected cancer, and 286 (7%) were found to have a previously undiagnosed medical problem. CONCLUSIONS: The living donor evaluation may lead to the early diagnosis of a life-threatening illness. This should be considered as one of the potential benefits of living donation.

Selection of More Vulnerable Patients for Cytomegalovirus Infection in Renal Transplant Recipients With Antithymocyte Globulin Induction Therapy: An Analysis of Risk Factors and Cell-Mediated Immunity.

BACKGROUND: Cytomegalovirus (CMV) infection is an important complication after kidney transplantation (KT). Antithymocyte globulin (ATG) increases the risk for CMV infection, and universal prophylaxis is recommended during the first 3 to 6 months after ATG induction in CMV-seropositive recipients. However, following this recommendation is not easy because the cost is high. The aim of this study was to determine who, among high-risk KT recipients, are more vulnerable to CMV infections. METHODS: We retrospectively analyzed the medical records of patients who underwent KT with ATG induction therapy at a single institute from April 2014 to June 2019. We assessed pretransplant recipient characteristics to determine the CMV infection risk factors. Cell-mediated immunity was evaluated with a lymphocyte subset test before transplantation and at the time of discharge. We included 227 patients in the study. RESULTS: CMV-DNAemia was associated with donor type (deceased donor), the duration of renal replacement therapy, and the ATG dose. Multivariable analysis revealed that donor type is the primary risk factor for CMV-DNAemia. We also found that CD4+ cell counts were significantly lower in CMV-DNAemia recipients at the time of discharge. CONCLUSION: The risk for CMV infection in CMV-seropositive KT recipients with ATG induction therapy increases when a graft is received from a deceased donor with renal impairment and when insufficient CD4+ cells are present during recovery.

Comparison of Short-Term Outcomes Between Endovenous 1,940-nm Laser Ablation and Radiofrequency Ablation for Incompetent Saphenous Veins.

Background: Radiofrequency ablation (RFA) has shown faster recovery and lower pain scores compared to Endovenous laser ablation (EVLA) for treatment of varicose veins. However, a comparison of 1,940-nm EVLA and RFA has not been reported. This study compared short-term outcomes using 1,940-nm EVLA and RFA for varicose veins. Methods: Between April 2018 and June 2018, 43 patients (83 incompetent saphenous veins) were treated with 1,940-nm EVLA and 37 patients (64 incompetent saphenous veins) with RFA. Follow-up duplex was checked at 1 month and 3 months. Results: Baseline characteristics showed no significant differences between both groups except for age. Pain scores at 6 h, and at 1, 10, and 30 days after treatment showed no differences. Complications and time to return to normal activity showed no differences. The 100% closure rate was checked in both groups at 1 month and 3 months follow-up. Conclusion: Short-term outcomes showed no significant differences between 1,940-nm EVLA and RFA treatment.

Incidence and outcome of isolated distal deep vein thrombosis in kidney transplant recipients.

PURPOSE: Isolated distal deep vein thrombosis (IDDVT) is a localized lesion; nonetheless, the risk of proximal vein propagation makes it difficult to decide on the treatment protocol-that is, whether immediate anticoagulation after diagnosis or surveillance via serial imaging should be employed. This study aimed to investigate the appropriate treatment protocol for IDDVT in kidney transplant recipient (KTR). METHODS: Surveillance for venous thromboembolism (VTE) was performed using duplex ultrasonography (DUS) before transplant surgery and at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year after transplant surgery. Dual mechanical prophylaxis was administered to prevent VTE. RESULTS: In total, 60 out of 829 patients (7.2%) developed VTE, with 49 cases (81.6%) of IDDVT. Among IDDVT patients, 15 patients were treated using anticoagulation-first strategy, whereas the remaining 34 patients were treated using surveillance-first strategy. No patient in either group exhibited thrombus extension into the proximal vein or recurrence within 1 year from transplant surgery. CONCLUSION: In Korean KTR, extension of IDDVT into the proximal vein could be prevented safely and effectively by serial DUS surveillance along with the maintenance of mechanical prophylaxis. However, the patients who have high thrombus burden or are difficult to get repeated DUS require the use of anticoagulation in early stages.

Venous Thromboembolism Following Abdominal Cancer Surgery in the Korean Population: Incidence and Validation of a Risk Assessment Model.

BACKGROUND: A cancer patient slated for abdominal surgery is considered to be at moderate to high risk for developing venous thromboembolism (VTE), but the incidence is quite low in Korean patients. Most risk assessment models and recommendations for VTE management are from Western reports, however they possibly overestimate the risk of VTE in the Korean population. METHODS: We retrospectively reviewed the medical records of 1966 patients who were diagnosed with abdominal organ cancer and required surgical treatment. RESULTS: Each patient was rated using the Caprini risk scoring model. The mean score was 7.5 ± 0.7 points; 98.4% of patients were classified as high risk for VTE. Symptomatic VTE occurred in eight patients, and the overall incidence was 0.4%. The mean Caprini score for VTE patients was 8.8 ± 1.9 points. In the group with scores between 5 and 9 points, the incidence was 0.3-0.5%, while in patients with scores > 10 points, the incidence of VTE was found to be 1.12%. CONCLUSIONS: The risk stratification system in the Caprini scoring model needs to be modified based on the actual incidence in the Korean population.

Exposure to Hyperchloremia Is Associated with Poor Early Recovery of Kidney Graft Function after Living-Donor Kidney Transplantation: A Propensity Score-Matching Analysis.

The effects of hyperchloremia on kidney grafts have not been investigated in patients undergoing living-donor kidney transplantation (LDKT). In this study, data from 200 adult patients undergoing elective LDKT between January 2016 and December 2017 were analyzed after propensity score (PS) matching. The patients were allocated to hyperchloremia and non-hyperchloremia groups according to the occurrence of hyperchloremia (i.e., ≥110 mEq/L) immediately after surgery. Poor early graft recovery was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 during the first 48 hours after surgery. After PS matching, no significant differences in perioperative recipient or donor graft parameters were observed between groups. Although the total amount of crystalloid fluid infused during surgery did not differ between groups, the proportions of main crystalloid fluid type used (i.e., 0.9% normal saline vs. Plasma Solution-A) did. The eGFR increased gradually during postoperative day (POD) 2 in both groups. However, the proportion of patients with eGFR > 60 mL/min/1.73 m2 on POD 2 was higher in the non-hyperchloremia group than in the hyperchloremia group. In this PS-adjusted analysis, hyperchloremia was significantly associated with poor graft recovery on POD 2. In conclusion, exposure to hyperchloremia may have a negative impact on early graft recovery in LDKT.

Comparison of Minimal Skin Incision Technique in Living Kidney Transplantation and Conventional Kidney Transplantation.

BACKGROUND: Recently, the most common incision for kidney transplantation (KT) is an inverted J-shaped incision known as the "hockey-stick." However, demands for minimally invasive surgery in KT are increasing as in other various fields of surgery. Hence, we evaluated whether there is difference between minimal skin incision technique in kidney transplantation (MIKT) and conventional KT (CKT) . METHODS: Between June 2006 and March 2013, a total of 452 living kidney transplant patients were enrolled. The MIKT group included 17 young unmarried women whose body mass index was <25 kg/m2 and had no anatomic variation. The CKT group included 435 patients. The MIKT operation technique restricted to the 10 cm-sized skin incision in the lower right abdomen from laterally below the anterior superior iliac spine to the midline just above the pubis was performed. We compared the baseline clinical characteristics and postoperative results between two groups. For proper comparison, propensity score matching was implemented. RESULTS: There was no difference in graft function, survival, and postoperative complication rate between MIKT and CKT groups (all P > 0.05). The 5-year graft survival was 92.3% and 85.7% in MIKT and CKT groups, respectively (P = 0.786). CONCLUSIONS: Our results indicated that MIKT showed more favorable cosmetic results, and there were no statistical differences in various postoperative factors including graft function, survival, and complications compared with CKT. Hence, we suggested that MIKT is an appropriate method for selected patients in living KT.

Prevalence of the Factor XIII Val34Leu Polymorphism in Korean Patients with Deep Vein Thrombosis.

OBJECTIVE: According to recent reports, a common polymorphism resulting in Val to Leu substitution, located 3 amino acids (Val34Leu) upstream of the thrombin cleavage site of FXIII A, has been related to a lower incidence of deep vein thrombosis (DVT). And, a different expression pattern has been shown across nations and races. However, the frequency of FXIII polymorphism expression in Koreans has not been reported in normal individuals or DVT-patient groups. DESIGN: Case-control study in Korean population. METHODS: We investigated the distribution of factor XIII Val34Leu polymorphisms in Korean patients of DVT (50 cases) and Korean healthy controls (100 cases), using real-time polymerase chain reaction for single nucleotide polymorphism genotyping. RESULTS: With regard to the frequency of the FXIII polymorphism in DVT patients and in the general control group, all 50 cases in the patient group and 100 cases in the control group were found to be Val34 homozygotes. CONCLUSIONS: The Val34Leu polymorphism of FXIII was not found in Korean people, and compared with Caucasians, a noticeably low incidence of DVT was shown. Thus, the preventive effect of the Val34 allele of FXIII on the formation of thrombi was shown.

Adventitial cystic disease of the common femoral vein presenting as deep vein thrombosis.

Adventitial cystic disease of the common femoral vein is a rare condition. We herein report the case of a 50-year-old woman who presented with painless swelling in her left lower leg that resembled deep vein thrombosis. She underwent femoral exploration and excision of the cystic wall. The presentation, investigation, treatment, and pathology of this condition are discussed with a literature review.

Clinical Importance of Intraoperative Cephalic Vein Distensibility as a Predictor of Radiocephalic Arteriovenous Fistula Maturation.

Radiocephalic arteriovenous fistula (RCAVF) is the preferred vascular access, but the maturation failure rate is high. Poor vein distensibility is the main cause of maturation failure. There have been several studies regarding vein distensibility, but vein dilation protocol and the cut-off value predicting maturation failure were inconsistent. We were doubtful that the vein distensibility had been appropriately evaluated, and sought to determine a more clinically applicable parameter. The cephalic vein was dilated via intraluminal hydrostatic pressure during the surgery and the vein size was measured. Maturation failure occurred in 30 patients (22.4%) and was more common in females and in patients who had a previous history of arteriovenous access formation (p = 0.0095 and p = 0.014). The intraoperative postdilation diameter, and the difference between pre and postdilation diameters differed between the two groups (p = 0.0004 and p = 0.0004). The cut-off value of the postdilation diameter, which indicated a high probability of maturation success, was >4 mm, and the cut-off value which indicated a higher probability of maturation failure; that is, the difference between the pre and postdilation diameter, was ≤2.2 mm. The degree of distensibility of the cephalic vein may be an important determinant of RCAVF maturation.

Endoscopic thyroid surgery via a breast approach: a single institution's experiences.

BACKGROUND: Thyroid carcinoma in young women is rapidly increasing, and cosmesis plays an important role in thyroid operations. Various endoscopic thyroid surgery approaches have been performed, and their application has recently been extended. We performed endoscopic thyroid surgeries via a breast approach since 1999. Herein, we evaluate the safety of this approach and identify the outcomes for differentiated thyroid carcinoma. METHODS: A total of 452 consecutive patients with thyroid and parathyroid disease underwent endoscopic thyroidectomy via a breast approach at Uijeongbu St. Mary's Hospital between November 1999 and December 2012. The inclusion criteria for endoscopic thyroidectomy included a benign tumour less than 4 cm in diameter, malignant thyroid nodules less than 2 cm, and no evidence of lymph node metastasis or local invasion. We analysed the clinicopathologic data and surgical factors of this approach. RESULTS: The mean age of the patients was 38.4 ± 10.6 years (range 11-73 years). The mean tumour size was 2.12 ± 1.17 cm (range 0.1-4 cm). The final tumour pathologies included papillary carcinoma (n = 120), follicular carcinoma (n = 8), nodular hyperplasia (n = 266), follicular adenoma (n = 43), and Hüthle cell adenoma (n = 4). The mean postoperative hospital stay was 3.8 ± 1.3 days (range 1-17 days). Temporary and permanent hypoparathyroidism requiring calcium and vitamin D supplementation developed in 32 (7.1%) and 4 (0.9%) patients, respectively. Transient vocal cord paresis occurred in 20 (4.4%) patients. CONCLUSIONS: For patients with benign and low-risk malignant thyroid disease, endoscopic thyroidectomy via a breast approach is a safe, feasible, and minimally invasive surgical method with minimal complications.

Aortic transection and diverting bypass as treatment of repetitive recurrent abdominal aortic false aneurysm rupture in a patient with Behcet's disease.

Abdominal aortic false aneurysms in patients with Behcet's disease have been reported frequently and repaired successfully by various procedures; however, anastomotic false aneurysms have often been reported to occur after the operation. In this article, we report a case of four-time repetitive, recurrent suprarenal abdominal aortic false aneurysm ruptures that lasted for 7 years. The location of this aneurysm was not easy to repair not only by open surgical procedures but by endovascular stent because the aortic defect was too close to the visceral arterial branches. The last operation consisted of primary repair of aortic defect, transection of abdominal aorta at the level of supraceliac aorta with end closure, and a thoracic aorta to abdominal aorta bypass with Dacron graft. An 8-year follow-up revealed no more abdominal aortic aneurysm recurrence.

Tuberculous pseudoaneurysm of the descending thoracic aorta.

Tuberculous mycotic aortic aneurysm is a rare disease with a high mortality rate.(1-5) Its prevalent location is the descending thoracic aorta in the patient with disseminated tuberculosis. Most of these aneurysms have been of the pseudoaneurysm type. We report the case of a 37-year-old woman with tuberculous pseudoaneurym of the descending aorta that was initially mistaken for a lung lesion and was successfully repaired surgically.