Factors predicting the usefulness of deceased donors.

BACKGROUND: Preoperative management for deceased donation is important. Deceased donation can failed for several reasons. We analyzed the clinical data of deceased donation after consent for cadaveric donation to evaluate the reasons of failure of organ procurement. MATERIAL AND METHODS: We retrospectively reviewed the medical records of 112 deceased donors in a single institution between January 1998 and September 2012. There were no organs from cardiac death donors. RESULTS: Of 112 deceased donors, 51 (45.5%) were traumatic brain deaths and 33 (29.5%), nontraumatic brain hemorrhages. The overall mean age was 37.2 (±16.6) years with 35 (30.7%) of female gender. There were 15 (13.3%) donation failures for all organs. Significant factors for failure were histories of cardiopulmonary resuscitation (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.05-0.58; P = .005), cardiac arrest (OR, 0.03; 95% CI, 0.006-0.14; P < .001), or acute renal failure (OR, 0.05; 95% CI, 0.006-0.42; P = .006). The nonsignificant factors included the time from intensive care unit to brain death (mean time, 105.1 ± 153.4); diabetes insipidus; hypotension despite inotrophic therapy, hypothermia (<35°C), arrhythmia, infection, metabolic acidosis, disseminated intravascular coagulopathy, and brain death cause. CONCLUSIONS: Failure of deceased donation was associated with cardiac arrest while awaiting organ procurement and the presence of an history of cardiopulmonary resuscitation or presence of acute renal failure.

The association of retinopathy and low GFR in type 2 diabetes.

AIMS: We sought to determine characteristics which strengthen the association between markers of diabetic kidney disease and retinopathy. METHODS: Multivariate regression analyses of NHANES 2005-2008 assessed the association of retinopathy with renal insufficiency and albuminuria. Analyses were stratified to evaluate ethnicity/race, obesity, and use of renin-angiotensin-aldosterone system antagonists as effect modifiers of this relationship. RESULTS: Of 269 participants with renal insufficiency, 35% had no microalbuminuria and no retinopathy; 16.1% had retinopathy with no microalbuminuria; 27.1% had microalbuminuria and no retinopathy and 22% had both microalbuminuria and retinopathy. Stratified, multivariate logistic regression analyses demonstrated retinopathy to be significantly predictive of renal insufficiency only in nonHispanic Blacks (OR=2.7; 95% CI 1.2, 6.1), obesity (OR=2.6; 95% CI 1.3, 5.5) and in those participants not using renin-angiotensin-aldosterone blockers (OR=2.5; 95% CI 1.1, 5.7). Analyses showed an independent relationship between retinopathy and albuminuria only when albuminuria was modeled continuously. CONCLUSIONS: In older onset diabetes, the absence of albuminuria and retinopathy is common among individuals with renal insufficiency. The relationship between microvascular complications of the eye and kidney may vary according to ethnicity, obesity and use of renin-angiotensin-aldosterone antagonists. These findings need to be confirmed in other large, diverse cohorts.

Development of a fluorescently labeled thermostable DHFR for studying conformational changes associated with inhibitor binding.

A fluorescently-labeled, conformationally-sensitive Bacillus stearothermophilus (Bs) dihydrofolate reductase (DHFR) (C73A/S131C(MDCC) DHFR) was developed and used to investigate kinetics and protein conformational motions associated with methotrexate (MTX) binding. This construct bears a covalently-attached fluorophore, N-[2-(1-maleimidyl)ethyl]-7-(diethylamino)coumarin-3-carboxamide (MDCC) attached at a distal cysteine, introduced by mutagenesis. The probe is sensitive to the local molecular environment, reporting on changes in the protein structure associated with ligand binding. Intrinsic tryptophan fluorescence of the unlabeled Bs DHFR construct (C73A/S131C DHFR) also showed changes upon MTX association. Stopped-flow analysis of all data can be understood by invoking the presence of two native state DHFR conformers that bind to MTX at different rates (20.2 and 0.067µM(-1)s(-1)), similar to previously published findings for Escherichia coli DHFR. Probe fluorescence of C73A/S131C(MDCC) DHFR predominantly reports on MTX binding to one of the conformers while intrinsic tryptophan fluorescence of C73A/S131C DHFR reports on binding to the other conformer. This study demonstrates the use of an extrinsic fluorophore attached to a distal region to investigate ligand binding interactions that are not experimentally accessible via intrinsic tryptophan fluorescence alone. The thermostability of C73A/S131C(MDCC) DHFR provides an important new tool with applications for investigating the temperature dependence of DHFR conformational changes associated with binding and catalysis.

Structural correlations between dermoscopic and histopathological features of juvenile xanthogranuloma.

Juvenile xanthogranuloma(JXG) is the variant of non-Langerhans' cell histiocytosis. The orange-yellow background coloration with clouds of paler yellow deposits is the most characteristic dermoscopic finding of JXG. Other dermoscopic features include erythematous border, subtle pigment network and white linear streak. The objective of this study was to present the structural correlation between dermoscopic features and histopathological findings of JXG and to find the different dermoscopic features in various stages of JXG. Eleven patients with histologically proven JXG were examined with polarized light dermoscopy. Histopathological findings were assessed and dermoscopic features including setting sun appearance, clouds of paler yellow globules, whitish streak, and branched and linear vessels were evaluated. Among 11 patients, five patients were in early evolutionary stage, four patients in fully developed stage and two in late regressive stage. The setting sun appearance was found in all patients in different stages except one in late regressive stage (90.9%). The clouds of paler yellow globules were present in nine patients (81.8%) and were constant features in fully developed stage and late regressive stage. The whitish streak was present in four patients (36.4%) and telangiectasia in 10 patients (81.8%). The setting sun appearance may hold diagnostic value in early evolutionary stage to fully developed stage, but not in late regressive stage. The clouds of paler yellow globules are more predominant in fully developed stage and late regressive stage. In addition to the use of dermoscopy as an accurate diagnostic tool for differential diagnosis, it could be applied in evaluation of histopathological maturation of JXG.

Scrub typhus in patients with liver cirrhosis: a preliminary study.

Scrub typhus is a potentially fatal infectious disease caused by the organism Orientia tsutsugamushi. However, to date, there have been no clearly identified determinants or reports published on the clinical severity of scrub typhus in liver cirrhosis (LC) patients. This study was carried out by retrospectively reviewing medical records accumulated over 7 years at a tertiary hospital. Sixteen patients of 160 had underlying LC, and they were defined as 'cases'; those without underlying LC were defined as 'controls'. The duration of hospital stay (23.0 +/- 24.8 days for cases and 6.8 +/- 7.0 days for controls, p 0.020) and APACHE II scores (14.1 +/- 6.0 for cases and 7.2 +/- 4.6 for controls, p <0.001) were, respectively, significantly longer and significantly higher on admission in the cases than in the controls. Surprisingly, hospital mortality was significantly higher in the cases than in the controls (31.3% and 3.5%, respectively, p 0.001). Among the LC group, the highest Model for End-stage Liver Disease (MELD) score during hospitalization (MELD-Peak) (p 0.024) and the lowest blood sodium concentration during hospitalization (MELD-Na-Lo) (p 0.003) were higher in fatal cases than in the survivors (MELD-Na-to). Physicians should be aware of an adverse relationship between LC and scrub typhus, and patients with LC should be advised to avoid exposure to O. tsutsugamushi, particularly in endemic areas and epidemic seasons.

Dermoscopic features of Bowen's disease in Asians.

BACKGROUND: Previously, dermoscopic features of Bowen's disease (BD) were extensively investigated in two studies, but there were some discrepancies. The dispute necessitated a further study concerning the dermoscopic features of BD. OBJECTIVE: To describe the dermoscopic features of BD in Asians and to assess dermoscopy as a post-treatment monitoring tool of BD. MATERIALS AND METHODS: Dermoscopic examinations of histopathologically diagnosed 26 BD lesions were performed to evaluate for the presence of various dermoscopic features. In addition, the correlating changes of dermoscopic features and histopathological results before and after treatments were assessed in five patients with BD. RESULTS: Dermoscopically, 10 lesions were pigmented and 16 lesions were non-pigmented. The most frequent dermoscopic findings of BD were vascular structures (96%) and a scaly surface (96%). Among vascular structure, glomerular vessels were most frequently observed (77%). The other vascular structures in our study were linear irregular vessels, dotted vessels, polymorphous/atypical vessels and arborizing vessels. Among five patients who had been treated with either photodynamic therapy or 5% imiquimod cream, four patients revealed disappearance of dermoscopic vascular structures, but one patient showed remaining vascular structures after treatment. Skin biopsy from treated lesions disclosed clearance of BD in four patients who had no vascular structures but remaining BD in the patient whose dermoscopic finding displayed no disappearance of vascular structures. CONCLUSIONS: Vascular structures, especially glomerular vessels plus a scaly surface, were common dermoscopic findings of BD in Asians. In addition, existence of dermoscopic vascular structures after treatment appears to be associated with residual disease.

Prospective, open-label, comparative study of clindamycin 1%/benzoyl peroxide 5% gel with adapalene 0.1% gel in Asian acne patients: efficacy and tolerability.

BACKGROUND: Used as individual agents, topical antibiotics and benzoyl peroxide are known to be effective in treatment of acne. Clindamycin phosphate 1% with benzoyl peroxide 5% (CDP/BPO) is a new combination gel, made by rationale, in that combination drug is more effective than either ingredients used alone. Adapalene 0.1% (ADA) is the third-generation retinoid, shown to be as effective as other topical retinoid with well tolerability. OBJECTIVES: To compare the efficacy and tolerability in combination of CDP/BPO in comparison with ADA in Asian patients with mild to moderate acne vulgaris. METHODS: Total of 69 patients, including 31 patients for CDP/BPO group and 38 for ADA group, with mild to moderate acne vulgaris were enrolled for a 12-week prospective, randomized, open-label comparative study of topical agents. Efficacy was assessed by lesion counts, acne grading system, and global improvement. Adverse events were also evaluated in scale of 0 (none) to 3 (severe). RESULTS: Both CDP/BPO and ADA were effective in reducing lesion counts and acne severity scale and showed significant global improvement. However, CDP/BPO offered greater efficacy against inflammatory lesions than ADA. Both drugs were well tolerated with minimal adverse drug reactions. CONCLUSION: Combination formulation of CDP/BPO and ADA were shown to be both effective in decreasing total, inflammatory, and non-inflammatory lesion counts along with well tolerability in Asian patients with mild to moderate acne vulgaris.

Tumescent superficial liposuction with curettage for treatment of axillary bromhidrosis.

BACKGROUND: Axillary bromhidrosis is a common but unpleasant and distressing problem faced by many societies, particularly in Asia, where malodour is reflected as a social handicap. Currently, local surgery is the treatment of choice among various non-surgical and surgical treatment. OBJECTIVES: To evaluate the clinical efficacy and safety of tumescent superficial liposuction and curettage in treating axillary bromhidrosis. METHODS: Forty-three patients (25 females and 18 males, average age 24.5 years) have undergone tumescent superficial liposuction and curettage. Local anaesthesia, tumescent solution, was injected into the hair-bearing area of the axilla. Two tiny incisions were made for Fatemi cannule, and subcutaneous tissue was removed by stroke movement under negative pressure. Subsequently, additional curettage was done around the incision sites. We evaluated the clinical efficacy (excellent, good, fair and poor) and complications. In addition, preoperative and postoperative histologic findings were reviewed in 15 patients. RESULTS: The follow-up evaluation started 3 months after the surgery, and mean follow-up period was 15.8 months, ranging from 3 to 54 months. Among 43 patients, 31 patients (72.1%) showed excellent to good results. The most common postoperative complication was transient ecchymosis which spontaneously regressed in 1 to 2 weeks. Focal skin necrosis, induration, and haematoma or seroma were each noted in four, three, and one patients, respectively, but resolved after proper dressing. The preoperative histological findings included increase in size and number of apocrine glands in cross-section view, and the postoperative specimen evidently showed removal of subcutaneous tissue, including apocrine and eccrine glands, and remnant sweat glands were severely destructed. CONCLUSION: Tumescent superficial liposuction with curettage for axillary bromhidrosis is an effective and safe treatment method for axillary bromhidrosis.

Epidemiologic and clinical survey of Behcet's disease in Korea: the first multicenter study.

The prevalence of Behcet's disease is the highest in the East Asian and the Mediterranean countries. Behcet's disease is also distributed in the Asian countries, but the nationwide survey has not been performed in Korea yet. The Korean Study Group for Behcet's Disease, founded in 1999, conducted a multicenter, retrospective survey on epidemiologic and clinical features of the patients with Behcet's disease from 20 hospitals around the nation from 1997 to 1999. Of 3,497 patients, 1,527 were classified into complete or incomplete type of Behcet's disease according to the revised Shimizu's classification. The sex ratio was 1:1.75 with the female predominance. Geographical distribution showed the highest frequency in Seoul (38.5%). Clinically, 98.8% had oral ulcers, 83.2% had genital ulcers, 84.3% had skin lesions and 50.9% had ocular lesions. As for the minor clinical manifestations, articular symptoms were the most frequent. The pathergy test showed positive in 15.4% of patients and revealed a higher positive rate in males (20.2%) than in females (12.7%). In conclusion, we performed the first multicenter study on Behcet's disease in Korea and revealed the female predominance, higher frequency of ocular lesions, and lower positivity of pathergy test in the patients.

Detection of telomerase activity in psoriasis lesional skin and correlation with Ki-67 expression and suppression by retinoic acid.

Telomerase activity is usually detected in most tumor tissues but not in normal tissues. Recently, there is increasing evidence that telomerase activity is associated with cell proliferation without malignancy, whereas there is little information about telomerase activity and its relationship with cell proliferation in chronic hyperproliferative skin diseases. Thus, we studied telomerase activity in skins from 10 patients with psoriasis and compared telomerase activity with the expression of Ki-67, a proliferation marker, using immunohistochemical staining. The effect of retinoic acid on the telomerase activity in HaCaT cells was also evaluated. Telomerase activity was detected in 7 (70%) of 10 lesional skins of psoriasis and none of the nonlesional skin. Telomerase activity in lesional skin was significantly associated with Ki-67 labelling index. Retinoic acid treatment on HaCaT cells inhibited telomerase activity, which correlated with inhibition of cell proliferation by the agent. The results of our study represent another example that shows telomerase activity correlates with cellular proliferation. Further studies on the regulation of the telomerase are needed to understand the cellular factors involved in controlling telomerase activity.