BACKGROUND: There has been a lack of study on the structural changes of serum albumin in patients with minimal change disease (MCD). To determine whether glycation and/or conformational transitions of albumin are involved in the pathogenesis of albuminuria, nine patients with MCD were enrolled in a prospective follow-up study for comparison of these parameters in serum albumin during the remission and relapse of nephrotic syndrome. METHODS: Circular dichroism measurements were made with purified albumin. Ellipticities at each wavelength were transformed to mean residue ellipticity. Monosaccharide composition was analyzed by high-pH anion-exchange chromatography with pulsed amperometric detection. RESULTS: There was no difference in the proportions of alpha-helix, beta-conformation, and beta-turn of albumin between the sera of control patients and those with nephrotic syndrome. However, the proportion of the random configuration was slightly higher in the plasma albumin of patients in relapse than in those in remission. The proportion of the random configuration was lower in the albumin of the serum than in the urine of patients with nephrotic syndrome, but there was no difference in the proportions of alpha-helix, beta-conformation, and beta-turn of albumin between their plasma and urine. CONCLUSION: Our results suggest that conformational changes in albumin are involved in albuminuria in patients with MCD.
Adult ; Albuminuria/urine ; Case-Control Studies ; Female ; Follow-Up Studies ; Glycosylation ; Humans ; Male ; Middle Aged ; Nephrosis, Lipoid/*blood/urine ; Nephrotic Syndrome/blood/urine ; Prospective Studies ; Research Support, Non-U.S. Gov't ; Serum Albumin/*chemistry

Focal segmental glomerulosclerosis (FSGS) in pediatric age tends to progress to end stage renal disease and to recur after renal transplantation. And recurrence of FSGS after kidney transplantation results in the graft loss in above half of cases. An unknown circulating factor in serum and immunologic dysfunction may be responsible for the recurrence. So, plasmapheresis to remove the uncertain serum factor and high dose cyclosporin A to control the immunologic system have been tried as the therapeutic regimen. We experienced 5 patients with recurrent FSGS after transplantation and tried plasmapheresis and methyl prednisolone pulse therapy with high dose cyclosporin A for them. The patients were 2 girls and 3 boys, aged between 8 and 14 years. In all cases, the kidney was donated by living related donors. Recurrence of FSGS was detected by postop. 3 days. Plasmapheresis started within 1 week after recurrence in 4 cases, and 2 months in 1 case. Early plasmapheresis brought rapid and sustained remission in 2 cases without evidence of acute rejection and short-term partial response in remaining 3 cases. In conclusion, plasmapheresis with high dose cyclosporin A resulted in a good outcome in recurrent FSGS. And starting plasmapheresis as early, prior to irreversible glomerular scarring, as possible is important for immediate and long-term prognosis in recurrent FSGS after renal transplantation.
Child ; Cicatrix ; Cyclosporine ; Female ; Glomerulosclerosis, Focal Segmental* ; Humans ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation* ; Plasmapheresis* ; Prednisolone ; Prognosis ; Recurrence ; Tissue Donors ; Transplants

BACKGROUND: The intracoronary stent implantation is accepted as the treatment modality to reduce restenosis in comparison with balloon angioplasty in patients with coronary artery disease. In recent studies, the technique of high pressure balloon dilation for stent optimization has been shown to improve procedural success and to reduce the subacute closure after stenting. The late clinical outcome, however, is still uncertain after stenting with high pressure balloon dilation. Therefore, we evaluated the effect of high pressure balloon dilation on subsequent clinical courses after intracoronary stenting. METHOD: One hundred sixty nine patients with 176 lesions were treated with Palmaz-Schatz stent implantation. Intracoronary stenting without high pressure balloon dilation was perforned in 55 patients with 55 lesions(phase 1), whereas intracoronary stenting with high pressure balloon dilation was done in 114 patients with 121 lesions(phase 2). We compared the angiographic and clinical results immediately and at late follow-up period after atenting between phase 1 and phase 2. RESULTS: Coronary angiography was repeated at 6 months in 135 patients, 138 lesions(78%). The overall incidence of restenosis was 25%(31% in phase 1 and 22% in phase 2). The restenosis occurred in 18% of elective stenting on de novo lesions(23% in phase 1 and 15% in phase 2). The restenosis rate was significantly reduced after using high pressure balloon dilation in infarct-related artery, final luminal diameter>/=4.0 mm after stenting and bail-out procedure(p<0.05). In phase 2, the restenosis rate was significantly higher in the lesions that had been previously dilated(43% in restenotic lesion vs 15% in de novo lesion, p<0.05) and in type C lesion compared with the others(type A, type B1, type B2 and type C ; 22%, 22%, 15% and 57%, respectively, p<0.05). According to the final luminal diameter, the restenosis rate was 7% in case of final luminal diameter greater than 4.0 mm which was significantly lower than that of final luminal diameter less than 3.5mm(p<0.05). At univariate anaysis, factors affecting restnosis were post-stent minimal luminal diameter, balloon-to-vessel ratio, acute gain and restenotic lesion. However multivariate analysis showed post-stent minimal luminal diameter was the only factor affecting restenosis. CONCLUSION: As intracoronary stenting using high pressure balloon dilation technique without anticoagulation has a good immediate results, negligible stent thrombosis and has a tendency of lower rate of restenosis.
Angioplasty, Balloon ; Arteries ; Coronary Angiography ; Coronary Artery Disease ; Dilatation* ; Follow-Up Studies ; Humans ; Incidence ; Multivariate Analysis ; Phenobarbital ; Stents* ; Thrombosis

Hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal complication after solid organ transplantation. Acquired forms of HLH are described in association with severe sepsis, autoimmune disorders, malignancy, immune-compromised states, infections, and solid organ transplantation. We experienced a case of hemophagocytic lymphohistiocytosis after bilateral lung transplantation. Leukopenia, thrombocytopenia, and hyperbilirubinemia were noted and became aggravated 50 days after transplantation. Diagnosis of HLH was based on clinical and laboratory findings of splenomegaly, cytopenia, elevated ferritin, elevated interleukin-2 receptor, and hemophagocytosis in bone marrow. Other features such as elevated bilirubin, lactate dehydrogenase, and D-dimer which can be present in HLH were also noted. The patient was immediately treated with etoposide and dexamethasone. Despite aggressive therapy, the patient deteriorated and died. Awareness of the diagnostic criteria of HLH after lung transplantation is important for clinicians.
Bilirubin ; Bone Marrow ; Dexamethasone ; Diagnosis ; Etoposide ; Ferritins ; Humans ; Hyperbilirubinemia ; Interleukin-2 ; L-Lactate Dehydrogenase ; Leukopenia ; Lung Transplantation* ; Lymphohistiocytosis, Hemophagocytic* ; Organ Transplantation ; Sepsis ; Splenomegaly ; Thrombocytopenia ; Transplants

Background: Patients with coronavirus disease 2019 (COVID-19) can unknowingly spread the virus to several people during the early subclinical period. Methods: We evaluated the viral dynamics in various body fluid specimens, such as nasopharyngeal swab, oropharyngeal swab, saliva, sputum, and urine specimens, of two patients with COVID-19 from hospital day 1 to 9. Additional samples of the saliva were taken at 1 hour, 2 hours, and 4 hours after using a chlorhexidine mouthwash. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load was determined by real-time reverse transcriptase polymerase chain reaction (rRT-PCR). Results: SARS-CoV-2 was detected from all the five specimens of both patients by rRT-PCR. The viral load was the highest in the nasopharynx (patient 1 = 8.41 log10 copies/mL; patient 2 = 7.49 log10 copies/mL), but it was also remarkably high in the saliva (patient 1 = 6.63 log10 copies/mL; patient 2 = 7.10 log10 copies/mL). SARS-CoV-2 was detected up to hospital day 6 (illness day 9 for patient 2) from the saliva of both patients. The viral load in the saliva decreased transiently for 2 hours after using the chlorhexidine mouthwash. Conclusion SARS-CoV-2 viral load was consistently high in the saliva; it was relatively higher than that in the oropharynx during the early stage of COVID-19. Chlorhexidine mouthwash was effective in reducing the SARS-CoV-2 viral load in the saliva for a short-term period.

In this study, we observed the alteration of choline signal intensity in hippocampus region of the depressive rat model induced by forced swimming test (FST). The purpose of this study was to evaluate the antidepressant efficacy in the depressive animal model using MR spectroscopy. Fourteen experimentally naive male Sprague-Dawley rats weighting 160~180 g were used as subjects. Drug injection group was exposed to the FST except for control group. The drugs were administered subcutaneously (SC) in a volume equivalent to 2 ml/kg. And three injections were administered 23, 5, and 1 h before beginning the given test. 1H MR spectra were obtained with use of a point resolved spectroscopy (PRESS) localization sequence performed according to the following parameters: repetition time, 2500 ms; echo time, 144 ms; 512 average; 2048 complex data points; voxel dimensions, 1.5x2.5x2.5 mm3; acquisition time, 25 min. There were no differences in NAA/Cr and Cho/Cr ratio between the right and the left hippocampus both normal control rats and antidepressant-injected rats. Also, no differences were observed in NAA/Cr and Cho/Cr ratio between the normal control rats and the antidepressant-injected rats both the right and the left hippocampus. In this study, we found the recovery of choline signals in the depressive animal model similar to normal control groups as injecting desipramine-HCl which was antidepressant causing anti-immobility effects. Thus, we demonstrated that MR spectroscopy was able to aid in evaluating the antidepressant effect of desipramine-HCl.
Animals ; Choline ; Hippocampus ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Models, Animal ; Protons ; Rats ; Rats, Sprague-Dawley ; Spectrum Analysis ; Swimming

PURPOSE: To identify prognostic factors for the outcomes of empirical antifungal therapy, we performed a multicenter, prospective, observational study in immunocompromised patients with hematological malignancies. MATERIALS AND METHODS: Three hundred seventy-six patients (median age of 48) who had neutropenic fever and who received intravenous (IV) itraconazole as an empirical antifungal therapy for 3 or more days were analyzed. The patients with possible or probable categories of invasive fungal disease (IFD) were enrolled. RESULTS: The overall success rate was 51.3% (196/376). Age >50 years, underlying lung disease (co-morbidity), poor performance status [Eastern Cooperative Oncology Group (ECOG) > or =2], radiologic evidence of IFD, longer duration of baseline neutropenic fever (> or =4 days), no antifungal prophylaxis or prophylactic use of antifungal agents other than itraconazole, and high tumor burden were associated with decreased success rate in univariate analysis. In multivariate analysis, age >50 years (p=0.009) and poor ECOG performance status (p=0.005) were significantly associated with poor outcomes of empirical antifungal therapy. Twenty-two patients (5.9%) discontinued itraconazole therapy due to toxicity. CONCLUSION: We concluded that empirical antifungal therapy with IV itraconazole in immunocompromised patients is effective and safe. Additionally, age over 50 years and poor performance status were poor prognostic factors for the outcomes of empirical antifungal therapy with IV itraconazole.
Antifungal Agents/adverse effects/*therapeutic use ; Female ; Hematologic Neoplasms ; Humans ; Immunocompromised Host ; Itraconazole/adverse effects/*therapeutic use ; Male ; Middle Aged ; Prospective Studies ; Republic of Korea

Hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal complication after solid organ transplantation. Acquired forms of HLH are described in association with severe sepsis, autoimmune disorders, malignancy, immune-compromised states, infections, and solid organ transplantation. We experienced a case of hemophagocytic lymphohistiocytosis after bilateral lung transplantation. Leukopenia, thrombocytopenia, and hyperbilirubinemia were noted and became aggravated 50 days after transplantation. Diagnosis of HLH was based on clinical and laboratory findings of splenomegaly, cytopenia, elevated ferritin, elevated interleukin-2 receptor, and hemophagocytosis in bone marrow. Other features such as elevated bilirubin, lactate dehydrogenase, and D-dimer which can be present in HLH were also noted. The patient was immediately treated with etoposide and dexamethasone. Despite aggressive therapy, the patient deteriorated and died. Awareness of the diagnostic criteria of HLH after lung transplantation is important for clinicians.
Bilirubin ; Bone Marrow ; Dexamethasone ; Diagnosis ; Etoposide ; Ferritins ; Humans ; Hyperbilirubinemia ; Interleukin-2 ; L-Lactate Dehydrogenase ; Leukopenia ; Lung Transplantation ; Lymphohistiocytosis, Hemophagocytic ; Organ Transplantation ; Sepsis ; Splenomegaly ; Thrombocytopenia ; Transplants

Serosurveillance studies reveal the actual disease burden and herd immunity level in the population. In Seoul, Korea, a cross-sectional investigation showed 0.07% anti-severe acute respiratory syndrome coronavirus-2 antibody seropositivity among 1,500 outpatients of the university hospitals. Low seroprevalence reflects well-implemented social distancing.Serosurveillance should be repeated as the pandemic progresses.