Background/Aims: Shifts in the gut microbiota and metabolites are interrelated with liver cirrhosis progression and complications. However, causal relationships have not been evaluated comprehensively. Here, we identified complication-dependent gut microbiota and metabolic signatures in patients with liver cirrhosis. Methods: Microbiome taxonomic profiling was performed on 194 stool samples (52 controls and 142 cirrhosis patients) via V3-V4 16S rRNA sequencing. Next, 51 samples (17 controls and 34 cirrhosis patients) were selected for fecal metabolite profiling via gas chromatography mass spectrometry and liquid chromatography coupled to timeof-flight mass spectrometry. Correlation analyses were performed targeting the gut-microbiota, metabolites, clinical parameters, and presence of complications (varices, ascites, peritonitis, encephalopathy, hepatorenal syndrome, hepatocellular carcinoma, and deceased). Results: Veillonella bacteria, Ruminococcus gnavus, and Streptococcus pneumoniae are cirrhosis-related microbiotas compared with control group. Bacteroides ovatus, Clostridium symbiosum, Emergencia timonensis, Fusobacterium varium, and Hungatella_uc were associated with complications in the cirrhosis group. The areas under the receiver operating characteristic curve (AUROCs) for the diagnosis of cirrhosis, encephalopathy, hepatorenal syndrome, and deceased were 0.863, 0.733, 0.71, and 0.69, respectively. The AUROCs of mixed microbial species for the diagnosis of cirrhosis and complication were 0.808 and 0.847, respectively. According to the metabolic profile, 5 increased fecal metabolites in patients with cirrhosis were biomarkers (AUROC >0.880) for the diagnosis of cirrhosis and complications. Clinical markers were significantly correlated with the gut microbiota and metabolites. Conclusions Cirrhosis-dependent gut microbiota and metabolites present unique signatures that can be used as noninvasive biomarkers for the diagnosis of cirrhosis and its complications.

Background: Light-chain amyloidosis (AL) is the most common form of systemic amyloidosis. This study aimed to evaluate the usefulness of laboratory tests for light-chain clonality and bone marrow (BM) findings in AL amyloidosis. Methods: We retrospectively enrolled patients newly diagnosed with AL amyloidosis on pathological examination who underwent a BM biopsy. Laboratory test data for light-chain clonality were collected and compared. Amyloid deposits were identified with H&E, Congo red, and PAS stains. Results: We reviewed 98 patients with AL amyloidosis. Light chain clonality (λ, 64 cases; κ, 34 cases) was detected by serum immunofixation electrophoresis (IFE) (63.3%), urine IFE (70.8%), serum protein electrophoresis (PEP) (44.9%), urine PEP (44.8%), serum free light chain (SFLC) ratio (79.5%), and BM immunohistochemistry (IHC) (85.7%). Flow cytometric (FCM) assay identified aberrant BM plasma cells in 92.9% of cases. BM amyloid deposits were identified in 35 of the 98 cases (35.7%); 71.4% (25/35) were Congo red-positive, and 100.0% (35/35) were PAS-positive. Conclusion Laboratory tests for detecting light-chain clonality in AL amyloidosis in order of sensitivity include FCM assay for aberrant plasma cells, IHC for light chains on BM biopsy or clot section, SFLC ratio, and serum and urine IFE. Congo red staining of BM samples remains an important tool for identifying amyloid deposits in BM. Periodic acid-Schiff (PAS) staining can be useful in diagnosing some cases of Congo red-negative amyloidosis.

Purpose: We evaluated the clinical manifestations and risk factors of fungal keratitis after penetrating keratoplasty (PKP). Methods: Eighteen patients who experienced fungal keratitis after PKP between January 2005 and January 2020 were included in this retrospective study. Clinical characteristics including sex, age, underlying disease, indication for PKP, symptom duration, visual acuity, graft state before infection, suture-related problems, size of epithelial defect, depth of infiltration, presence of hypopyon, use of eyedrops before infection, and the results of microbiological tests were analyzed. Patients were classified into the treatment success or failure group, and the risk factors were evaluated accordingly. Results: The mean age at diagnosis was 63.94 ± 15.53 years. Fungal infection occurred a mean of 55.31 ± 44.72 months after PKP. The mean symptom duration was 10.33 ± 7.36 days. Of the 18 patients, 5 (27.8%) and 13 (72.2%) were in the treatment success and failure groups, respectively. Of the treatment failure group, seven patients (38.9%) underwent surgical management. The graft state before infection, symptom duration, and size of epithelial defects had significant correlations with treatment failure (all p < 0.05). Multivariate analysis identified graft state (p = 0.046) as a significant risk factor for treatment failure. Conclusions Graft state before infection, symptom duration, and size of epithelial defects were associated with the prognosis of fungal keratitis after PKP. Graft state before infection was a significant risk factor for treatment failure.

Purpose: To evaluate the clinical efficacy of preservative-free 0.15% sodium hyaluronate eye drops on the ocular surface after upper eyelid surgery. Methods: This study included 43 patients who underwent upper eyelid surgery between December 2018 and May 2019. Patients were randomly assigned to group A (those treated with preservative-free 0.15% sodium hyaluronate eye drops) and group B (the control group). Ocular surface disease index score (OSDI), tear break up time (TBUT), Schirmer’s test, corneal staining score (CSS), meibomian gland (MG) quality, MG expressibility, and meiboscore were evaluated before surgery and at 1 week, 1 month, and 2 months after surgery. Results: In group A, OSDI and TBUT showed a significant increase at 1 week after surgery compared with baseline values (all p < 0.05). In group B, OSDI, TBUT, and CSS were significantly higher at 1 week and 1 month after surgery (all p < 0.05), whereas there were no significant changes at 2 months after surgery compared with baseline values. At 1 month after surgery, OSDI (p = 0.03) and CSS (p < 0.01) showed significant changes between group A and group B; however, there was no significant change in the TBUT. There were no significant within-group differences in Schirmer’s test values, MG quality, MG expressibility, or meiboscore, and there were no significant between-group differences over time. Conclusions Preservative-free 0.15% sodium hyaluronate eye drops were shown to be an effective treatment for early dry-eye symptoms and ocular surface damage after upper eyelid surgery.

Background: Plasma cell myeloma (PCM) is caused by immune dysregulation. We evaluated the expression of immune checkpoint programmed cell death protein-1 (PD-1) on T cell subsets in PCM patients according to disease course and cytogenetic abnormalities.This study aimed to find a target group suitable for therapeutic use of PD-1 blockade in PCM. Methods: A total of 188 bone marrow (BM) samples from 166 PCM patients and 32 controls were prospectively collected between May 2016 and May 2017. PD-1 expression on BM T cell subsets was measured using flow cytometry. Results: At diagnosis, the median PD-1 expression on CD4+ T cells was 24.6%, which did not significantly differ from that in controls. After stem cell transplantation, PD-1 expression on CD4+ T cells was higher than that at diagnosis (P < 0.001), regardless of residual disease. PD-1 expression on CD4+ T cells in patients with residual disease after chemotherapy was significantly higher than that at diagnosis (P = 0.001) and after complete remission following chemotherapy (P = 0.044). PD-1 expression on CD8+ T cells was higher in PCM patients with cytogenetic abnormalities, including monosomy 13, 1q gain, complex karyotype, and hypodiploidy. Conclusions PD-1 blockade might have therapeutic potential in refractory PCM patients after chemotherapy, especially in those with high- or intermediate-risk cytogenetic abnormalities.

Purpose: We evaluated the clinical manifestations and risk factors of fungal keratitis after penetrating keratoplasty (PKP). Methods: Eighteen patients who experienced fungal keratitis after PKP between January 2005 and January 2020 were included in this retrospective study. Clinical characteristics including sex, age, underlying disease, indication for PKP, symptom duration, visual acuity, graft state before infection, suture-related problems, size of epithelial defect, depth of infiltration, presence of hypopyon, use of eyedrops before infection, and the results of microbiological tests were analyzed. Patients were classified into the treatment success or failure group, and the risk factors were evaluated accordingly. Results: The mean age at diagnosis was 63.94 ± 15.53 years. Fungal infection occurred a mean of 55.31 ± 44.72 months after PKP. The mean symptom duration was 10.33 ± 7.36 days. Of the 18 patients, 5 (27.8%) and 13 (72.2%) were in the treatment success and failure groups, respectively. Of the treatment failure group, seven patients (38.9%) underwent surgical management. The graft state before infection, symptom duration, and size of epithelial defects had significant correlations with treatment failure (all p < 0.05). Multivariate analysis identified graft state (p = 0.046) as a significant risk factor for treatment failure. Conclusions Graft state before infection, symptom duration, and size of epithelial defects were associated with the prognosis of fungal keratitis after PKP. Graft state before infection was a significant risk factor for treatment failure.

Purpose: To evaluate the clinical efficacy of preservative-free 0.15% sodium hyaluronate eye drops on the ocular surface after upper eyelid surgery. Methods: This study included 43 patients who underwent upper eyelid surgery between December 2018 and May 2019. Patients were randomly assigned to group A (those treated with preservative-free 0.15% sodium hyaluronate eye drops) and group B (the control group). Ocular surface disease index score (OSDI), tear break up time (TBUT), Schirmer’s test, corneal staining score (CSS), meibomian gland (MG) quality, MG expressibility, and meiboscore were evaluated before surgery and at 1 week, 1 month, and 2 months after surgery. Results: In group A, OSDI and TBUT showed a significant increase at 1 week after surgery compared with baseline values (all p < 0.05). In group B, OSDI, TBUT, and CSS were significantly higher at 1 week and 1 month after surgery (all p < 0.05), whereas there were no significant changes at 2 months after surgery compared with baseline values. At 1 month after surgery, OSDI (p = 0.03) and CSS (p < 0.01) showed significant changes between group A and group B; however, there was no significant change in the TBUT. There were no significant within-group differences in Schirmer’s test values, MG quality, MG expressibility, or meiboscore, and there were no significant between-group differences over time. Conclusions Preservative-free 0.15% sodium hyaluronate eye drops were shown to be an effective treatment for early dry-eye symptoms and ocular surface damage after upper eyelid surgery.

BACKGROUND: Waldenström macroglobulinemia (WM) is a subset of lymphoplasmacytic lymphoma (LPL) with bone marrow (BM) involvement and an IgM monoclonal gammopathy of any level. We aimed to identify the clinical, laboratory, and BM findings of patients with WM and to evaluate the usefulness of CD154 for the diagnosis and prognosis of WM. METHODS: We reviewed the medical records and BM studies and/or flow cytometric immunotyping of 31 patients with untreated WM. Semiquantitative immunohistochemistry (CD20, CD138, tryptase, and CD154) of BM was performed. RESULTS: Only six patients presented with symptoms of hyperviscosity syndrome. Eleven patients had solid cancer and/or another hematologic malignancy. Mast cells (MC) increased in all samples, with some in close contact with tumor cells. Tryptase-positive MC (17.1/ high-power fields [HPF], 1.2–72.0/HPF) and CD154-positive MC (8.6/HPF, 0.1–31.1/HPF) were observed. The high CD154-positive MC (≥8.6/HPF) group showed a lower overall five-year survival rate than the low CD154-positive MC (<8.6/HPF) group (71.9% vs. 100.0%; P=0.012). Flow cytometric immunophenotyping of BM aspirates showed increased B lymphocytes and plasma cells with a normal phenotype (CD138⁺/CD38⁺/CD19⁺/CD45⁺/CD56⁻). CONCLUSIONS Approximately one third of WM patients showed other malignancies and all patients had increased MC. Immunohistochemistry and flow cytometric immunophenotyping are useful for diagnosing WM, and increased CD154-positive MC can indicate poor prognosis.

POEMS syndrome is a rare paraneoplastic syndrome, which includes polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes due to plasma cell (PC) neoplasm. Diagnosis of this disease is challenging because of its rarity and complex clinical manifestations. We attempted to identify the key clinical features and characteristic bone marrow (BM) findings of POEMS syndrome, by reviewing the medical records and BM analyses of 24 Korean patients. Frequent clinical manifestations included polyneuropathy (100%), monoclonal gammopathy (100%), organomegaly (92%), extravascular volume overload (79%), and endocrinopathy (63%). The BM analyses revealed mild PC hyperplasia (median PCs: 5.5%) and frequent megakaryocytic hyperplasia (88%), megakaryocyte clusters (88%), and hyperlobation (100%). Flow cytometry of BM aspirates using CD138/CD38/CD45/CD19/CD56 showed normal (67%, 4/6) or neoplastic PC immunophenotypes (33%, 2/6). A diagnosis of POEMS syndrome must be considered when a patient suspected of having PC dyscrasia shows the above clinical presentation and BM findings.
Bone Marrow ; Diagnosis ; Flow Cytometry ; Humans ; Hyperplasia ; Medical Records ; Megakaryocytes ; Paraneoplastic Syndromes ; Paraproteinemias ; Plasma Cells ; POEMS Syndrome ; Polyneuropathies ; Skin

PURPOSE: The purpose of this study was to examine nursing organizational culture and resilience and their effects on quality of nursing service. METHODS: A cross-sectional study was conducted. A convenience sampling method was used to collect data from 199 participants who worked in a tertiary hospital in G city. Demographic and work related variables, quality of nursing service, resilience, and nursing organizational culture were measured using validated self-report questionnaires. RESULTS: All of the participants were women and the majority were staff nurses and single. A statistically significant difference in quality of nursing service was found for age, marital status, educational level, clinical career, position and perceived health status. Age, educational level, clinical career, position, resilience, innovation-oriented culture, relation-oriented culture, and hierarchy-oriented culture were significant predictors of quality of nursing service, explaining 47% of total variance. Among the predictors, resilience was the strongest predictor, followed by innovation-oriented culture, and hierarchy-oriented culture. CONCLUSION: Findings indicate that quality of nursing service can be improved by raising individual nurse's resilience and advancing nursing organizational culture. Considering the identified factors, researchers and administrators need to develop and provide clinical nurses with a variety of programs to improve the quality of their nursing service.
Administrative Personnel ; Cross-Sectional Studies ; Female ; Humans ; Marital Status ; Methods ; Nursing Services ; Nursing ; Organizational Culture ; Tertiary Care Centers