PURPOSE: Neointimal hyperplasia (NH) is considered to be one of the main causes of vascular access occlusion in patients receiving hemodialysis. Endothelial injury and TGF-β-mediated proliferation of vascular smooth muscle cells (VSMCs) induce NH. Endothelial microparticles (EMPs) are also increased by endothelial injury. We aimed to investigate the effects of EMPs and TGF-β expression on VSMC proliferation and their contributions to NH formation in an ex vivo model. METHODS: EMPs were collected from the culture media of human umbilical vein endothelial cells treated with indoxyl sulfate (IS, 250 µg/mL) after ultracentrifugation at 100,000 × g. Porcine internal jugular veins were isolated and treated with EMPs (2 × 10⁶ /mL) or left untreated for 12 days and subsequently compared with TGF-β (10 ng/mL)-treated venous tissue. Intima-media thickness and NH area were assessed using a digital program. Masson's trichrome staining and immunohistochemistry (IHC) analysis for α-smooth muscle actin, phosphorylated Akt, ERK1/2, p38 mitogen-activated protein kinase (MAPK), and Smad3 were performed on each vein sample. RESULTS: NH and VSMC proliferation developed to a significantly greater degree in EMP-treated veins compared to controls, with similar patterns seen in TGF-β-stimulated samples. IHC analysis demonstrated that EMPs markedly increased phosphorylation of Akt, ERK1/2, p38 MAPK, and Smad3 in areas of venous NH formation. CONCLUSION: Our results showed that IS-induced EMPs provoked massive VSMC proliferation and NH formation via activation of the TGF-β signaling pathways. Further investigation is needed to elucidate the precise mechanism of EMP activity on vascular access stenosis in vivo.

A clinical prediction model can be applied to several challenging clinical scenarios: screening high-risk individuals for asymptomatic disease, predicting future events such as disease or death, and assisting medical decision-making and health education. Despite the impact of clinical prediction models on practice, prediction modeling is a complex process requiring careful statistical analyses and sound clinical judgement. Although there is no definite consensus on the best methodology for model development and validation, a few recommendations and checklists have been proposed. In this review, we summarize five steps for developing and validating a clinical prediction model: preparation for establishing clinical prediction models; dataset selection; handling variables; model generation; and model evaluation and validation. We also review several studies that detail methods for developing clinical prediction models with comparable examples from real practice. After model development and vigorous validation in relevant settings, possibly with evaluation of utility/usability and fine-tuning, good models can be ready for the use in practice. We anticipate that this framework will revitalize the use of predictive or prognostic research in endocrinology, leading to active applications in real clinical practice.
Asymptomatic Diseases ; Checklist ; Consensus ; Dataset ; Endocrinology ; Health Education ; Mass Screening

Erosive pustular dermatosis of the scalp is a rare disorder of the elderly and it is characterized by pustular, erosive and crusted lesions of the scalp with progressive scarring alopecia. The predisposing factors have been reported to be trauma, including mechanical trauma, skin grafting, surgery and prolonged exposure of a bald scalp to UV light. Yet the laboratory data, the bacteriological and mycological investigations and the histopathologic findings of the previously reported cases were generally negative and not diagnostic. We herein present a case of erosive pustular dermatosis of the scalp that occurred after mechanical trauma on the previous skin graft site. This type of case has not been previously reported in the Korean dermatologic literature.
Aged ; Alopecia ; Cicatrix ; Humans ; Scalp ; Skin ; Skin Diseases ; Skin Transplantation ; Transplants ; Ultraviolet Rays

Nocardia species are aerobic, gram-positive pathogens found worldwide in soil. Nocardia is considered an opportunistic pathogen, and its infection mostly occurs in immunocompromised patients. We report a case of Nocardia farcinica induced mediastinitis and pneumonia that occurred in a 64-year-old male patient who had no significant medical history except for hypertension. He visited another hospital with a complaint of dyspnea and left chest wall pain. The symptoms arose 7 days ago without any trauma and they worsened. A mediastinal mass was found on computed tomography scan. After being transferred to our hospital for further evaluation, he was diagnosed with mediastinitis and pneumonia. As N. farcinica was found to be the causative organism by 16S rRNA sequencing, proper antibiotic therapy including trimethoprim/sulfamethoxazole was initiated immediately. After this, the patient improved and he was discharged. If an infection has a disseminating course, nocardiosis cannot be excluded even in immunocompetent patients. Once the diagnosis is established, prompt antibiotic therapy should be performed based on the severity.
Diagnosis ; Dyspnea ; Humans ; Hypertension ; Immunocompromised Host ; Male ; Mediastinitis* ; Middle Aged ; Nocardia Infections ; Nocardia* ; Pneumonia* ; Soil ; Thoracic Wall

PURPOSE: This study aimed to determine the mortality rate in patients with severe trauma and the risk factors for trauma mortality based on 3 years' data in a regional trauma center in Korea. METHODS: We reviewed the medical records of severe trauma patients admitted to Ajou University Hospital with an Injury Severity Score (ISS) > 15 between January 2010 and December 2012. Pearson chi-square tests and Student t-tests were conducted to examine the differences between the survived and deceased groups. To identify factors associated with mortality after severe trauma, multivariate logistic regression was performed. RESULTS: There were 915 (743 survived and 172 deceased) enrolled patients with overall mortality of 18.8%. Age, blunt trauma, systolic blood pressure (SBP) at admission, Glasgow Coma Scale (GCS) at admission, head or neck Abbreviated Injury Scale (AIS) score, and ISS were significantly different between the groups. Age by point increase (odds ratio [OR], 1.016; P = 0.001), SBP < or = 90 mmHg (OR, 2.570; P < 0.001), GCS score < or = 8 (OR, 6.229; P < 0.001), head or neck AIS score > or = 4 (OR, 1.912; P = 0.003), and ISS by point increase (OR, 1.042; P < 0.001) were significant risk factors. CONCLUSION: In severe trauma patients, age, initial SBP, GCS score, head or neck AIS score, and ISS were associated with mortality.
Abbreviated Injury Scale ; Blood Pressure ; Glasgow Coma Scale ; Head ; Humans ; Injury Severity Score ; Korea ; Logistic Models ; Medical Records ; Mortality* ; Neck ; Risk Factors* ; Trauma Centers ; Wounds and Injuries

When treating trauma patients with severe hemorrhage, massive transfusions are often needed. Damage control resuscitation strategies can be used for such patients, but an adequate fresh frozen plasma: packed red blood cell (FFP:PRBC) administration ratio must be established. We retrospectively reviewed the medical records of 100 trauma patients treated with massive transfusions from March 2010 to October 2012. We divided the patients into 2 groups according to the FFP:PRBC ratio: a high-ratio (> or =0.5) and a low-ratio group (<0.5). The patient demographics, fluid and transfusion quantities, laboratory values, complications, and outcomes were analyzed and compared. There were 68 patients in the high-ratio and 32 in the low-ratio group. There were statistically significant differences between groups in the quantities of FFP, FFP:PRBC, platelets, and crystalloids administered, as well as the initial diastolic blood pressure. Bloodstream infections were noted only in the high-ratio group, and the difference was statistically significant (P=0.028). Kaplan-Meier plots revealed that the 24-hr survival rate was significantly higher in the high-ratio group (71.9% vs. 97.1%, P<0.001). In severe hemorrhagic trauma, raising the FFP:PRBC ratio to 0.5 or higher may increase the chances of survival. Efforts to minimize bloodstream infections during the resuscitation must be increased.
Acute Lung Injury/epidemiology/etiology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacterial Infections/epidemiology ; *Blood Transfusion/adverse effects ; *Erythrocyte Transfusion/adverse effects ; Female ; Hemorrhage/etiology/*prevention & control ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Patients ; Respiratory Distress Syndrome, Adult/epidemiology/etiology ; Resuscitation ; Retrospective Studies ; Wounds and Injuries/complications/mortality/*therapy ; Young Adult

PURPOSE: In 2008, the Korean Oncology Nursing Society (KONS) published standards for the safe use of chemotherapy in clinical settings, including extravastion management. Although the medical environment has rapidly changed, KONS standards have not been revised since then. In 2017, the KONS planned to revise the practice guidelines on oral chemotherapy METHODS: A clinical expert group developed recommended guidelines, using officially accepted standards based on all relevant publications. The draft was discussed and accepted in a consensus conference. The final recommendations were reviewed and approved by the KONS Boards of Directors. RESULTS: There were 4 chapters and 50 recommendations in the final version of the guidelines. Recommendations include those associated with general practice, patient consent and education, order assessment and administration, and side effects and complication management. CONCLUSION: The revised KONS guidelines on oral chemotherapy will contribute to the improvement of staff and patient safety related to oral chemotherapy. KONS guidelines revisions should be carried out at regular intervals.
Consensus ; Drug Therapy* ; Education ; General Practice ; Humans ; Oncology Nursing* ; Patient Safety ; Personal Protective Equipment ; Safety Management

On the phytochemical investigation of a 70% ethanol extract of the fruits of Opuntia ficus-indica, (Cacataceae), we could result in the isolation of thirteen phenolic compounds including seven flavonoids (1 - 9) and four simple phenolic glycosides (10 - 13) by column chromatographic methods. Among the isolated compounds, picein (11), androsin (12), and 1-O-feruloyl-β-D-glucopyranoside (13) were isolated for the first time from O. ficus-indica; additionally, this is the first report benzyl-O-β-D-glucopyranoside (10) from the genus Opuntia. The structures of the compounds were determined by spectral data analysis which included 1D, 2D NMR spectrum and ESIMS.
Ethanol ; Flavonoids ; Fruit* ; Glycosides ; Opuntia* ; Phenol* ; Statistics as Topic

BACKGROUND: Anti-topoisomerase I antibodies (anti-topo-I) have been known to be a specific serologic marker for systemic sclerosis (SSc). However, anti-topo-I have also been detected fre-quently in the sera of patients with diagnosis other than SSc since the enzyme linked immunosor-bent assay (ELISA) has been used widely. In order to clarify the clinical significance of anti-topo-I on ELISA, we analyzed the clinical features of the patients positive for anti-topo-I. METHODS: Anti-topo-I and other antinuclear antibodies (ANA) were investigated by conventional ELISA methods. The clinical characteristics were analyzed in 38 patients positive for anti-topo-I and 28 patients with SLE but negative for anti-topo-I. RESULTS: Of 38 patients positive for anti-topo-I, 15 were SLE and eight SSc. The mean level of anti-topo-I in the patients with SSc was higher than that in the patients with SLE (P=0.015). Of 15 anti-topo-I positive patients with SLE, 14 had one or more other ANAs in their sera whereas only one of eight anti-topo-I positive patients with SSc did (P=0.000). There was no significant difference in clinical characteristics between anti-topo-I positive and negative patients with SLE. The preva-lences of restrictive lung disease in both groups with SLE were significantly lower than that in the anti-topo-I positive patients with SSc (P=0.008). CONCLUSIONS: Anti-topo-I is not exclusively specific for SSc and present in a considerable subset of SLE. As well as the level of anti-topo-I, the coexistence of other ANAs is helpful to discriminate SLE from SSc. The Anti-topo-I detected by ELISA does not seem to be a risk factor for restrictive lung disease in the patients with SLE, unlike those with SSc.
Antibodies* ; Antibodies, Antinuclear ; Diagnosis ; Enzyme-Linked Immunosorbent Assay* ; Humans ; Lung Diseases ; Risk Factors ; Scleroderma, Systemic

OBJECTIVE: A system for reinforcing the patient safety has been established based on RFID (Radio Frequency Identification) technology in order to minimize a variety of potential medical errors which can take place in hospitals. The system is intended to prevent simple errors or misunderstandings attributed to manifold surgery, transfusion, and medication errors. METHODS: The RFID system was developed and established in one general hospital. The system was applied to managing the patient in the run-up to surgery during anesthesia preparation, transfusion, and anticancer medications, of which procedure information and the patient information are rechecked for assurance, respectively. RESULTS: With regard to the technological aspects, the system used 13.56 MHz of spectrum bandwidth and tags complying with ISO 15693 standard. The tag readers varied with the work, PDAs in the intensive care unit, and laptop computers in the anesthesiology department and on the general wards. After applying the system, we surveyed user's usage and satisfaction. CONCLUSION: The results of our survey indicated a high level of satisfaction with the RFID system in terms of reinforcing the patient's safety in medical environments. Respondents stated that patients were likely to wear an electronic bracelet, even if inconvenient, with their information revealed on the wrist and while going through extended medical procedures. Nurses had intentions to utilize the RFID system for managing hospital assets and tracking patients. A revitalization of the RFID system would be network stability, including the network environment, as well as quantitative effectiveness analysis.
Anesthesia ; Anesthesiology ; Surveys and Questionnaires ; Electronics ; Electrons ; Hospitals, General ; Humans ; Hypogonadism ; Intensive Care Units ; Intention ; Medical Errors ; Medication Errors ; Mitochondrial Diseases ; Ophthalmoplegia ; Patient Safety ; Patients' Rooms ; Radio Frequency Identification Device ; Track and Field ; Wrist