No abstract available.
Mycobacterium*

BACKGROUND: The purpose of this study was to calculate the measurement uncertainty of the process of bone mineral density (BMD) analysis using dual energy X-ray absorptiometry with traceability. METHODS: Between March 2015 and October 2016, among healthy participants in their 20s and 30s, the study included those who had not taken calcium, vitamin D supplements and steroids and were without a history of osteoporosis, osteopenia and diseases related to osteoporosis. Relational expression of the model was established based on Guide to the Expression of Uncertainty in Measurements and Eurachem and the uncertainty from each factor was evaluated. RESULTS: The combined standard uncertainty was 0.015, while the expanded uncertainty was 0.0298. The factor-specific standard uncertainties that occurred in the process of measuring BMD were 0.72% for the calibration curve, 0.9% for the internal quality control (IQC) using Aluminum Spine Phantom, 0.58% for European Spine Phantom (ESP), and 0.9% for the inspector precision (IP). CONCLUSIONS: The combined standard uncertainty of the spine BMD corrected with ESP was 0.015 when measured at one time and targeting one participant. The uncertainties of the accuracy of the IQC and the IP were higher than that of the other factors. Therefore, there will be a need for establishment of protocols to lower these uncertainties.
Absorptiometry, Photon* ; Aluminum ; Bone Density* ; Bone Diseases, Metabolic ; Calcium ; Calibration ; Healthy Volunteers ; Lumbar Vertebrae ; Osteoporosis ; Quality Control ; Spine* ; Steroids ; Uncertainty* ; Vitamin D

No abstract available.
Humans ; Hypersensitivity* ; Phenytoin*

OBJECTIVES: The aim of this study is to enhance understanding the clinical features, pathogenesis, diagnosis and treatment of gouty arthritis in Korea by analyzing the clinical manifestations of the patients with urate crystal-proven gouty arthritis. METHODS: 78 cases who had been diagnosed as gouty arthritis by confirming the urate crystals in synovial fluids or tophi in Seoul National University Hospital between January 1, 1989 and July 31, 1995 were analysed for their histories, symptoms, signs, laboratory data, and X-ray findings. RESULTS: 1) Male to female ratio was 18.5:1. The mean age of onset is 49.3 +/- 14.5 years(range 11-83 years); the mean duration of disease 6.5 +/- 7.0 years(range 0-30 years); the mean duration of gouty attack 7.2 +/- 5.5 days(range 1-30 days). 2) The frequent precipitating factors of gouty arthritis were hospitalization(37%) and alcohol drinking(15%). The most frequent accompanying disease was hypertension(24%). Obesity, diabetes, chronic renal failure, hyperlipidemia, ischemic heart diseases, or cerebrovascular diseases were also accompanied by gouty arthritis. 3) The patterns of joint involvement were devided into 3 groups: monoarthritis; 42%, oligoarthritis; 35%, polyarthritis; 23%, The most frequent site of the first gouty attack was the 1st toe(65%). The most frequently involved joint at gouty attack was also the 1st toe(68%). While only lower extremities were involved in most cases with monoarthritis and oligoarthritis(91% and 78%, respectively), both lower and upper extremities were involved in most cases with polyarthritis(78%). 4) Hyperuricemia was found in 74% of the cases at gouty attack. But serum uric acid level was normal in 26%. With respect to pathogenesis of hyperuricemia, 14% of the cases had uric acid overproduction and 86% had uric acid underexcretion. 5) Bony changes in radiologic findings were found in 47% of the cases and tophi in 33%. Bony changes and tophi was significantly related to the younger age of gouty onset and higher serum uric acid level at gouty attack. 6) Acute gouty arthritis responded well to colchicine and NSAIDs. There was no difference in efficacy and the frequency of side effects between them. CONCLUSION: The clinical features of the gouty arthritis in Korea showed no difference from those in foreign studies except higher prevalence of oligo-/polyarthritis and tophi. To be remarkable, 26% of the patients with gouty arthritis did not have hyperuricemia at gouty attack. This finding indicates that urate crystals should be confirmed by synovial fluid examination for diagnosis of gouty arthritis.
Age of Onset ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis ; Arthritis, Gouty* ; Colchicine ; Diagnosis ; Female ; Gout ; Humans ; Hyperlipidemias ; Hyperuricemia ; Joints ; Kidney Failure, Chronic ; Korea ; Lower Extremity ; Male ; Myocardial Ischemia ; Obesity ; Precipitating Factors ; Prevalence ; Seoul ; Synovial Fluid ; Upper Extremity ; Uric Acid

Myasthenia gravis(MG) is an autoimmune disorder characterized by the presence of anti-acetylcholine receptor antibody and weakness of voluntary muscles. The pathogenesis of MG is decreased numbers of acetylcholine receptors at postsynaptic membranes of neuromuscular junctions. It has been reported that MG often coexists with other autoimmune disorders. This is a case report of systemic lupus erythematosus coexisting with MG in a 23 year old female patient presenting with dysarthria, dysphagia, and limb weakness. We report the case with relevant literature review.
Deglutition Disorders ; Dysarthria ; Extremities ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Membranes ; Muscle, Skeletal ; Myasthenia Gravis* ; Neuromuscular Junction ; Receptors, Cholinergic ; Young Adult

No abstract available.
Arthritis, Psoriatic* ; HLA-B27 Antigen ; Korea* ; Prevalence* ; Psoriasis ; Spondylitis

OBJECTIVE: The aim of this study was to analyze the correlation between thromboembolic complications and antiplatelet drugs before and after neurointervention. METHODS: Blood samples and radiographic data of patients who received a neurointervention (coil embolization, stent placement or both) were collected prospectively. Rapid platelet function assay-aspirin (RPFA-ASA) was used to calculate aspirin resistance in aspirin reaction units (ARU). For clopidogrel resistance, a P2Y12 assay was used to analyze the percentage of platelet inhibition. ARU > 550 and platelet inhibition < 40% were defined as aspirin and clopidogrel resistance, respectively. RESULTS: Both aspirin and clopidogrel oral pills were administered in fifty-three patients before and after neurointerventional procedures. The mean resistance values of all patients were 484 ARU and < 39%. Ten (17.0%) of 53 patients showed resistance to aspirin with an average of 597 ARU, and 33 (62.3%) of 53 patients showed resistance to clopidogrel with an average of < 26%. Ten patients demonstrated resistance to both drugs, 5 of which suffered a thromboembolic complication after neurointervention (mean values : 640 ARU and platelet inhibition < 23%). Diabetic patients and patients with hypercholesterolemia displayed mean aspirin resistances of 513.7 and 501.8 ARU, and mean clopidogrel resistances of < 33.8% and < 40.7%, respectively. CONCLUSION: Identifying individuals with poor platelet inhibition using standard regimens is of great clinical importance and may help prevent cerebral ischemic events in the future. Neurointerventional research should focus on ideal doses, timing, choices, safety, and reliable measurements of antiplatelet drug therapy, as well as confirming the clinical relevance of aggregometry in cerebrovascular patients.
Aspirin ; Blood Platelets ; Drug Resistance ; Humans ; Hypercholesterolemia ; Platelet Aggregation Inhibitors ; Prospective Studies ; Stents ; Ticlopidine

OBJECTIVE: To investigate the autoantibody profile and its clinical association in patients with systemic lupus erythematosus. METHODS: The frequency and clinical correlation of autoantibodies were studied in 73 patients with systemic lupus erythematosus who have been followed in Seoul National University Hospital. Double immunodiffusion, ELISA and immunoblot were used for the detection of autoantibodies. RESULTS: The frequency of each autoantibody measured by double immunodif fusion was as follows; anti-Ro 53.4%, anti-La 11.0%, anti-Sm 20.5%, anti-U1 RNP 20.5%. The frequency of each autoantibody by ELISA was as follows; anti-Ro 69.9%, anti-La 27.4%, anti-Sm 54.8%, anti-Ul RNP 68.5%, anti-dsDNA 72.6%, anti-cardiolipin 47.2% (IgG 43.1?0, igM 15. 3%). The frequency of each autoantibody by immunoblot was as follows; anti-Ro 15.1?0, anti-La 42. 5%, anti-Sm 46. 6%, anti-U1 RNP 42. 5%. anti-ribosomal P(P0) 27.4%. Anti-Ro was associated with decreased frequency of nephrotic syndrome. Anti-U1 RNP was associated with increased frequency of malar rash, Raynaud phenomenon and decreased frequency of nephritis. Patients with both anti-Ro and anti La had more frequent serositis than those with anti-l~o only. Patients with both anti-Sm and anti-U1 RNP had less frequent thrombocytopenia than those with anti-U1 RNP only. And patients with anti-Sm and anti-dsDNA had more frequent arthritis than those with only one of both antibodies. There was a positive correlation of autoantibody titers between anti-Ro and anti-La, anti-Sm and anti-U1 RNP, anti-dsDNA and anti-cardiolipin(IgG). Taking the result of immunoblot as a standard, both of double immunodiffusion and ELISA showed low sensitivity but high specficity for anti La. As for anti-Sm and anti-U1 RNP, double immunodiffusion showed low sensitivity but high specificity, whereas ELISA showed high sensitivity but low specificity. CONCLUSIONS: In our study, some autoantibodies (anti-Ro, anti-U1 RNP) were associated with certain clinical manifestations while others not. Immunoblot being used as a standard method, ELISA showed higher sensitivity but lower specificity for anti-La, anti-Sm and anti-U1 RNP compared with immunodiffusion. It is recommended that in interpretating the laboratory findings of these autoantibodies these parameters of each method should be considered.
Antibodies ; Arthritis ; Autoantibodies ; Blotting, Western* ; Enzyme-Linked Immunosorbent Assay* ; Exanthema ; Humans ; Immunodiffusion* ; Immunoglobulin M ; Lupus Erythematosus, Systemic ; Nephritis ; Nephrotic Syndrome ; Raynaud Disease ; Sensitivity and Specificity ; Seoul ; Serositis ; Thrombocytopenia

Filaggrin is expressed in the cornified layer of epidermis and known to be one of the antigenic targets in rheumatoid arthritis. Although the citrulline residue in filaggrin is thought to be an antigenic determinant recognized by autoantibodies, the diagnostic sensitivity of synthetic citrullinated peptide is variable. To investigate the implication of anti-filaggrin antibodies recognizing uncitrullinated filaggrin in rheumatoid arthritis, we assayed antibody titers using unmodified recombinant filaggrin in the sera from 73 patients with rheumatoid arthritis, 150 patients with other connective tissue diseases and 70 normal controls. We also performed the correlation analysis between antibody titers and the clinical variables in patients with rheumatoid arthritis. Titers of IgG anti-filaggrin antibodies were significantly higher in rheumatoid arthritis patients compared to normal controls (P=0.02), but not in patients with osteoarthritis, ankylosing spondylitis or systemic lupus erythematosus. IgG anti-filaggrin antibodies were more frequently found in patients with rheumatoid arthritis compared to normal controls (12.3% vs 1.4% respectively, P=0.04). An anti-filaggrin antibody titer was correlated with visual analogue scale of pain, tender joint count, Ritchie articular index or C-reactive protein, but not with anti-nuclear antibody or rheumatoid factor. These results suggest that anti-filaggrin antibody recognizes the uncitrullinated filaggrin as an antigen and its titer correlates with clinical parameters, explaining the variable sensitivity of anti-filaggrin antibody test.
Amino Acid Sequence ; Antibodies/*blood/*immunology ; Arthritis, Rheumatoid/blood/*diagnosis/*immunology ; Case-Control Studies ; Citrulline/*analysis ; Humans ; Intermediate Filament Proteins/*chemistry/*immunology/isolation & purification ; Molecular Sequence Data ; Research Support, Non-U.S. Gov't

Subclinical hypothyroidism (SCH), characterized by elevated serum thyroid-stimulating hormone (TSH) levels and normal free thyroxine levels, usually presents without symptoms, and is often discovered incidentally during routine blood test. The Task Force of the Korean Thyroid Association Committee of Clinical Practice Guidelines has established a guideline to evaluate and manage SCH; the guideline emphasizes the implementation of diagnostic criteria based on the TSH reference range for Koreans and focuses on the proven health benefits of levothyroxine (LT4) treatment. Based on the Korea National Health and Nutrition Examination Survey (2013-2015), serum TSH level of 6.8 mIU/L is considered the reference value for SCH. SCH can be categorized as mild (TSH 6.8-10.0 mIU/L) or severe (TSH ＞10.0 mIU/L), and patients are classified as adults (age ＜70 years) or elderly patients (age ≥70years) depending on the health effects of LT4 treatment. An initial increase in serum TSH levels should be reassessed with a subsequent measurement, along with the thyroid peroxidase antibody test, preferably 2-3 months after the initial evaluation. Usually, LT4 treatment is not recommended for mild SCH in adults; however, treatment is necessary for severe SCH in patients with underlying coronary artery disease or heart failure and can be considered for coexisting dyslipidemia. LT4 treatment is not recommended for mild or even severe SCH in elderly patients, in general. Patients with SCH who receive LT4 treatment, the LT4 dosage should be personalized, and serum TSH levels should be monitored to ensure optimal LT4 dosage (dosage that is neither excessive nor insufficient). Patients with SCH who do not receive LT4 treatment require periodic follow-up at appropriate testing intervals determined by disease severity. The guideline also provides several educational points applicable in clinical settings.