BACKGROUND: Immature platelet fraction (IPF) is the percentage of reticulated platelet (RP) of total platelet count. We measured an IPF reference range using XE-2100 blood cell counter with upgraded software (Sysmex, Japan) and evaluated the clinical utility of this parameter for the laboratory diagnosis of thrombocytopenia due to an increase in peripheral platelet destruction. METHODS: Peripheral blood samples collected into K2 EDTA (Beckton Dickinson, USA) were analyzed at Chonbuk National University Hospital. One hundred forty-two samples from apparently healthy adults (all routine full blood count parameters including platelets within the healthy reference range) were used to establish a normal reference range for IPF. The patients were classified into 3 groups including hypoplastic (consisted of 22 patients undergoing chemotherapy with falling platelet counts and 14 with aplastic anemia), cirrhotic (40 with cirrhosis of liver), and idiopathic thrombocytopenic purpura (ITP) (14 with ITP) groups. RESULTS: An IPF reference range in healthy individuals was established as 0.4-5.4%, with a mean of 1.7%. A significant increase in IPF values was found in the ITP patient group. The cut-off value of IPF was 6.1% and its sensitivity and specificity were 92.9%, and 82.9% respectively. Reproducibility was good. CONCLUSIONS: A rapid, inexpensive automated method for measuring IPF is feasible and should become a standard parameter in evaluating thrombocytopenic patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Middle Aged ; Platelet Count/*methods ; Stem Cells/cytology ; Thrombocytopenia/*diagnosis

BACKGROUND: It is known that magnesium can inhibit platelet function in vitro and ADP-induced platelet activation. We wished to demonstrate if magnesium could inhibit activation of platelets preserved at cold temperature. METHODS: We incubated each mixture of platelets and various concentrations of magnesium sulfate (0~10 mM) at room temperature and at a cold temperature (4oC). On days 1, 3, 5, 7 and 9, we measured the platelet count, pH, LD level, glucose level, HCO3?? level, lactate level, expression of CD62P, expression of annexin V, and ADP-induced aggregation of platelets. RESULTS: The platelets stored at 4oC showed a similar LD level but a lower platelet count, lactate level, and expression of CD62P and annexin V, and a higher pH and glucose level than platelets stored at room temperature. With an increasing magnesium concentration, expression of CD62P in the platelets stored at 4oC was slightly decreased, but expression of annexin V was increased. ADP-induced aggregation of the platelets stored at 4oC was not affected by magnesium. CONCLUSION: Magnesium did not effectively inhibit activation of platelets during preservation at cold temperature (4oC).
Annexin A5 ; Blood Platelets ; Cold Temperature* ; Glucose ; Hydrogen-Ion Concentration ; Lactic Acid ; Magnesium Sulfate* ; Magnesium* ; Platelet Activation ; Platelet Count

Immune thrombocytopenia is a rare complication associated with vancomycin. A 76-year-old male patient who was treated with vancomycin experienced severe thrombocytopenia and refractoriness as a result of platelet transfusion. Vancomycin-dependent antibodies in his thrombocytopenic serum were detected by flow cytometric analysis. The mechanism of thrombocytopenia is probably related to immunological destruction, as strongly suggested by its association with a specific drug-dependent anti-platelet antibody.
Aged ; Antibodies ; Humans ; Male ; Platelet Transfusion ; Thrombocytopenia ; Vancomycin

Granulocytic sarcoma of the uterine adnexa is a rare event. A 50-year-old woman, who had previously been diagnosed as chronic myeloid leukemia (CML), but had a complete hematologic response, presented with lower abdominal pain and a large pelvic mass involving the right uterine adnexa region and extending to the right posterior wall of the bladder and right distal ureter. A biopsy of the uterine adnexa revealed granulocytic sarcoma, and a subsequent bone marrow biopsy confirmed the diagnosis of CML in the blastic phase.
Abdominal Pain ; Adnexa Uteri ; Biopsy ; Bone Marrow ; Diagnosis ; Female ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Middle Aged ; Recurrence* ; Sarcoma, Myeloid* ; Ureter ; Urinary Bladder

BACKGROUND: This study was conducted to establish reference intervals (RIs) for serum gamma-glutamyltransferase (GGT), and to evaluate the association between serum GGT levels within RIs and the prevalence of metabolic syndrome (MetS) and type 2 diabetes mellitus (DM) in men and women. METHODS: A total of 363 healthy adults (137 men and 226 women) were enrolled for establishing the RIs of serum GGT. A cross-sectional study was conducted with 919 individuals (519 men and 400 women) to evaluate the associations between gender-specific serum GGT RI quartiles and prevalence of MetS and DM. RESULTS: The RIs for serum GGT levels (central 95th percentile ranges) were 9.0-70.6 IU/L and 4.0-31.3 IU/L in men and women, respectively. In men, the odds ratios (ORs) and 95% confidence intervals (CIs) for the prevalence of MetS in 4 serum GGT quartiles (lowest to highest) were 1.0 (reference), 3.6 (0.7-18.0), 8.8 (2.0-39.1), and 17.4 (4.0-75.3), respectively, while the ORs (95% CIs) for the prevalence of DM were 1.0 (reference), 1.0 (0.3-3.0), 1.7 (0.6-4.6), and 2.6 (1.0-6.6), respectively. In women, the corresponding ORs (95% CIs) were 1.0 (reference), 3.3 (0.6-16.6), 5.8 (1.2-27.3), and 18.8 (4.3-82.2) for MetS, respectively, and 1.0 (reference), 1.6 (0.3-9.7), 1.6 (0.3-9.9), and 8.0 (1.7-36.7) for DM, respectively. These significant relationships persisted after adjusting for age, alcohol intake, body mass index, and smoking. CONCLUSIONS: Serum GGT levels, even within RIs, were proportionally associated with prevalence of metabolic syndrome and DM in both men and women. Serum GGT level may be an independent predictor for chronic degenerative diseases.
Adult ; Body Mass Index ; Cross-Sectional Studies ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Electrolytes ; Female ; gamma-Glutamyltransferase ; Humans ; Male ; Odds Ratio ; Prevalence

BACKGROUND: Malignant hyperthermia (MH) is genetically heterogeneous, with mutations in the gene encoding the skeletal muscle ryanodine receptor (RYR1) at 19q13.1 accounting for up to 80% of the cases. However, the search for known and novel mutations in the RYR1 gene is hampered by the fact that the gene contains 106 exons. We aimed to analyze mutations from the entire RYR1 coding region in Korean MH families. METHODS: We investigated seven affected MH individuals and their family members. The entire RYR1 coding region from the genomic DNA was sequenced, and RYR1 haplotyping and mutational analysis were carried out. RESULTS: We identified nine different RYR1 mutations or variations from seven Korean MH families. Among these, five previously reported mutations (p.Gly248Arg, p.Arg2435His, p.Arg2458His, p.Arg2676Trp, and p.Leu4838Val) and four novel variations of unknown significance (p.Arg2508Cys, p.Met4022Val, p.Glu2669Lys, and p.Ala4295Val) were identified. In two families, two variations (R2676W & M4022V, R2435H & A4295V, respectively) were identified simultaneously. Four of the observed nine mutations or variations were located outside the hotspot region of RYR1 mutations. CONCLUSIONS: These data indicate that RYR1 is a main candidate gene in Korean MH families, and that comprehensive screening of the entire coding sequence of the RYR1 gene is necessary for molecular genetic investigations in MH-susceptible individuals, owing to the presence of RYR1 mutations or variations outside of the hotspot region.
Adult ; Asian Continental Ancestry Group/*genetics ; Child ; DNA Mutational Analysis ; Exons ; Female ; Genetic Predisposition to Disease ; Haplotypes ; Humans ; Male ; Malignant Hyperthermia/*genetics ; Middle Aged ; Mutation, Missense ; Pedigree ; Republic of Korea ; Ryanodine Receptor Calcium Release Channel/*genetics ; Sequence Analysis, DNA

OBJECTIVE: To investigate the analgesic effect of transcranial direct current stimulation (tDCS) over the primary motor (M1), dorsolateral prefrontal cortex (DLPFC), and sham tDCS in patients with painful diabetic polyneuropathy (PDPN). METHODS: Patients with PDPN (n=60) were divided randomly into the three groups (n=20 per group). Each group received anodal tDCS with the anode centered over the left M1, DLPFC, or sham stimulation for 20 minutes at intensity of 2 mA for 5 consecutive days. A blinded physician rated the patients' pain using a visual analog scale (VAS), Clinical Global Impression (CGI) score, anxiety score, sleep quality, Beck Depression Inventory (BDI), and the pain threshold (PT) to pressure. RESULTS: After the tDCS sessions, the M1 group showed a significantly greater reduction in VAS for pain and PT versus the sham and DLPFC groups (p<0.001). The reduction in VAS for pain was sustained after 2 and 4 weeks of follow-up in the M1 group compared with the sham group (p<0.001, p=0.007). Significant differences were observed among the three groups over time in VAS for pain (p<0.001), CGI score (p=0.01), and PT (p<0.001). No significant difference was observed among the groups in sleep quality, anxiety score, or BDI score immediately after tDCS. CONCLUSION: Five daily sessions of tDCS over the M1 can produce immediate pain relief, and relief 2- and 4-week in duration in patients with PDPN. Our findings provide the first evidence of a beneficial effect of tDCS on PDPN.
Anxiety ; Chronic Pain ; Depression ; Diabetic Neuropathies* ; Electrodes ; Follow-Up Studies ; Humans ; Pain Threshold ; Prefrontal Cortex ; Visual Analog Scale

OBJECTIVE: To improve lower extremity function and balance in elderly persons, we developed a novel, three-dimensional interactive augmented reality system (3D ARS). In this feasibility study, we assessed clinical and kinematic improvements, user participation, and the side effects of our system. METHODS: Eighteen participants (age, 56-76 years) capable of walking independently and standing on one leg were recruited. The participants received 3D ARS training during 10 sessions (30-minute duration each) for 4 weeks. Berg Balance Scale (BBS) and the Timed Up and Go (TUG) scores were obtained before and after the exercises. Outcome performance variables, including response time and success rate, and kinematic variables, such as hip and knee joint angle, were evaluated after each session. RESULTS: Participants exhibited significant clinical improvements in lower extremity balance and mobility following the intervention, as shown by improved BBS and TUG scores (p<0.001). Consistent kinematic improvements in the maximum joint angles of the hip and knee were observed across sessions. Outcome performance variables, such as success rate and response time, improved gradually across sessions, for each exercise. The level of participant interest also increased across sessions (p<0.001). All participants completed the program without experiencing any adverse effects. CONCLUSION: Substantial clinical and kinematic improvements were observed after applying a novel 3D ARS training program, suggesting that this system can enhance lower extremity function and facilitate assessments of lower extremity kinematic capacity.
Aged* ; Education ; Exercise ; Feasibility Studies* ; Hip ; Humans ; Joints ; Knee ; Knee Joint ; Leg ; Lower Extremity ; Reaction Time ; Rehabilitation* ; Walking

BACKGROUND: Oral anticoagulation with warfarin requires routine monitoring of prothrombin time to maintain the international normalized ratio (INR) within the appropriate therapeutic range. Coagu- Chek XS (Roche Diagnositic, Germany) is a portable coagulometer that measures the INR. We evaluated the precision and accuracy of CoaguCheck XS by comparing it with CA-1500 (Sysmex, Japan). METHODS: We analyzed the CV and the correlation of all INR results measured in 68 samples obtained from patients treated with warfarin and 10 samples from control subjects with no history of anticoagulant therapy with CoaguChek XS and CA-1500. We compared the turn-around time between two instruments and evaluated the differences between the results obtained with venous and capillary blood samples and those obtained with different lots of the test strip. We also evaluated the precision of the two instruments in 5 repeated tests with samples of normal and increased INR. RESULTS: Mean INR values of 5 repeated tests with the same samples were similar. The correlation of INR values between two instruments was excellent (r2=0.97, P=0.001), and the difference in the values between the two instruments was mostly within the 95% limit of agreement, but was shown to increase in direct proportion to INR values. The turn-around time of CoaguChek XS was shorter than that of CA-1500. The differences between venous and capillary blood and between different lots of the test trip were not significant (P>0.05). CONCLUSIONS: CoaguChek XS showed a good precision and correlation with CA-1500 with a very short turn-around time. This instrument should be clinically useful in monitoring INR of patients with oral anticoagulation.
Administration, Oral ; Anticoagulants/administration & dosage/pharmacology/*therapeutic use ; Drug Monitoring ; Humans ; International Normalized Ratio/*instrumentation ; Prothrombin Time/*instrumentation/methods ; Reproducibility of Results ; Self Care/instrumentation/methods ; Warfarin/administration & dosage/*therapeutic use

Microscopic examination of peripheral blood smear (PBS) for detection of microorganisms is simple method that can be used for doctors to confirm the septicemia more swiftly and to select more specific therapy. But it is unusual to find microorganisms in PBS. We report a case of gram negative bacteremia diagnosed by PBS in a severe thrombocytopenic pediatric surgical patient. A 6-month and 2 week old baby with cyanosis was diagnosed congenital heart diseases such as transposition of great arteries, atrial septal defect, and patent ductus arteriosus. The infant underwent surgical operations and the postoperative platelet count progressively decreased in spite of transfusion of multiple platelet concentrates. We performed routine examination of a PBS for evaluation of severe thrombocytopenia. The PBS revealed severe thrombocytopenia, leukopenia with left shifted and some extracellular bacilli. Toxic granulations, toxic vacuoles and some bacilli were observed in the neutrophils. The bacilli were identified as Pseudomonas aeruginosa and Serratia marcescens in blood culture. To our knowledge, this is the second case of bacteremia diagnosed by PBS before the positive blood culture in Korea. We suggest that a PBS is useful for the rapid detection of organisms in cases of septicemia with severe thrombocytopenic pediatric surgical patient.
Bacteremia ; Blood Platelets ; Cyanosis ; Ductus Arteriosus, Patent ; Heart Diseases ; Heart Septal Defects, Atrial ; Humans ; Infant ; Korea ; Leukopenia ; Neutrophils ; Platelet Count ; Pseudomonas aeruginosa ; Sepsis ; Serratia marcescens ; Thrombocytopenia ; Transposition of Great Vessels ; Vacuoles