Invasive aspergillosis (IA) is a leading cause of infectious mortality in patients who have undergone a hematopoietic stem cell transplant (HSCT); the mortality due to IA ranges from 70% to 93% in HSCT patients. Early diagnosis and treatment are the cornerstones for the good prognosis of IA. Primary renal aspergillosis is an extremely rare presentation in patients who have undergone HSCT, and the risk factor for this uncommon presentation is not well known. We report a patient who developed primary renal aspergillosis and renal stones in both the kidneys after HSCT. Invasive renal aspergillosis was diagnosed after a nephrectomy, which was performed to treat massive renal hematoma.
Aspergillosis ; Early Diagnosis ; Hematoma ; Hematopoietic Stem Cells ; Humans ; Kidney ; Nephrectomy ; Prognosis ; Risk Factors ; Transplants

BACKGROUND: Lung cancer is the most common cause of cancer-related death, and adenocarcinoma is the most common histologic subtype. MicroRNA is a small non-coding RNA that inhibits multiple target gene expression at the post-transcriptional level and is commonly dysregulated in malignant tumors. The purpose of this study was to analyze the expression of microRNA-374a (miR-374a) in lung adenocarcinoma and correlate its expression with various clinicopathological characteristics.METHODS: The expression level of miR-374a was measured in 111 formalin-fixed paraffin-embedded lung adenocarcinoma tissues using reverse transcription-quantitative polymerase chain reaction assays. The correlation between miR-374a expression and clinicopathological parameters, including clinical outcome, was further analyzed.RESULTS: High miR-374 expression was correlated with advanced pT category (chi-square test, p=.004) and pleural invasion (chi-square test, p=.034). Survival analysis revealed that patients with high miR-374a expression had significantly shorter disease-free survival relative to those with low miR-374a expression (log-rank test, p=.032).CONCLUSIONS: miR-374a expression may serve as a potential prognostic biomarker for predicting recurrence in early stage lung adenocarcinoma after curative surgery.
Adenocarcinoma ; Disease-Free Survival ; Gene Expression ; Humans ; Lung Neoplasms ; Lung ; MicroRNAs ; Polymerase Chain Reaction ; Recurrence ; RNA, Small Untranslated

PURPOSE: The modified Hanley technique, which is used for treatment of a deep horseshoe fistula, has reduced damage to the external anal sphincter compared to the classic Hanley technique, but its shortcoming is that it causes inconvenience to the patient due to the fact that a drainage tube must be left in place for a long time. To solve this problem, the authors devised a self-pulsed washable seton and then compared the results of its use to determine its clinical usefulness. METHODS: The subjects of this study were 34 patients who were diagnosed with a deep posterior complex anal fistula and who were operated on by using the modified Hanley technique between January 1999 and December 2004. Twelve patients who were treated with the self-pulsed washable seton were classified as Group A, and 12 patients who were treated by using a conventional loose seton were placed in Group B. These two groups were compared for period of purulent discharge, period of leaving the seton alone, and recurrence rate. RESULTS: The period of purulent discharge was 18.75 days (15~24) for group Aand 29.75 days (24~37) for group B. The period of leaving the seton was 21.58 days (18~29) for group A and 32.58 days (28~39) for group B. The recurrence rate after surgery was 8.3% in group A and 16.7% in group B. CONCLUSIONS: The self-pulsed washable seton devised by the authors shortened the treatment period through more effective wound management, so we propose using it as a new method for treating a deep posterior horseshoe fistula.
Anal Canal ; Drainage ; Fistula ; Humans ; Hypogonadism ; Mitochondrial Diseases ; Ophthalmoplegia ; Rectal Fistula ; Recurrence

No abstract available.
Kidney Pelvis*

BACKGROUND: Obstetric patients with placenta previa are at risk for sever peripartum hemorrhage. Early detection of anemia and proper transfusion strategy are important for the management of obstetric hemorrhage. In this study, we assessed the utility and accuracy of noninvasive hemoglobin (SpHb) monitoring in patients with placenta previa during cesarean section.METHODS: Parturients diagnosed with placenta previa and scheduled for cesarean section under spinal anesthesia were enrolled. SpHb and laboratory Hb (Lab-Hb) were measured during surgery as primary outcomes.RESULTS: Seventy-four pairs of SpHb and Lab-Hb were collected from 39 patients. The correlation coefficient was 0.877 between SpHb and Lab-Hb (P < 0.001). The Bland-Altman plot showed a mean difference ± SD of 0.3 ± 0.8 g/dl between noninvasive Hb and Lab-Hb, and the limits of agreement were −1.2 to 1.8 g/dl. The magnitude of the difference between SpHb and Lab-Hb was < 0.5 g/dl in 64.9%; however, it was > 1.5 g/dl in 10.8%.CONCLUSIONS: SpHb monitoring had a good correlation with Lab-Hb. A small mean difference between SpHb and lab-Hb might not be clinically significant; however, the limits of agreements were not narrow. In particular, SpHb could be overestimated in the anemic population. Based on our results, further studies investigating the accuracy and precision of SpHb monitoring should be performed in parturients presenting Hb below 10 g/dl.
Anemia ; Anesthesia, Spinal ; Cesarean Section ; Female ; Hemorrhage ; Humans ; Observational Study ; Peripartum Period ; Placenta Previa ; Placenta ; Pregnancy ; Prospective Studies

Objectives: This study was conducted to develop a generalizable annotation tool for bilingual complex clinical text annotation, which led to the design and development of a clinical text annotation tool, ANNO. Methods: We designed ANNO to enable human annotators to support the annotation of information in clinical documents efficiently and accurately. First, annotations for different classes (word or phrase types) can be tagged according to the type of word using the dictionary function. In addition, it is possible to evaluate and reconcile differences by comparing annotation results between human annotators. Moreover, if the regular expression set for each class is updated during annotation, it is automatically reflected in the new document. The regular expression set created by human annotators is designed such that a word tagged once is automatically labeled in new documents. Results: Because ANNO is a Docker-based web application, users can use it freely without being subjected to dependency issues. Human annotators can share their annotation markups as regular expression sets with a dictionary structure, and they can cross-check their annotated corpora with each other. The dictionary-based regular expression sharing function, cross-check function for each annotator, and standardized input (Microsoft Excel) and output (extensible markup language [XML]) formats are the main features of ANNO. Conclusions With the growing need for massively annotated clinical data to support the development of machine learning models, we expect ANNO to be helpful to many researchers.

PURPOSE: Decitabine, a DNA hypomethylating agent, was recently approved for use in Korea for older adults with acute myeloid leukemia (AML) who are not candidates for standard chemotherapy. This study aimed to evaluate the role of decitabine as a first-line treatment for older adults with AML. MATERIALS AND METHODS: Twenty-four patients with AML who received at least one course of decitabine (20 mg/m²/d intravenously for 5 days every 4 weeks) as a first-line therapy at Severance Hospital were evaluated retrospectively. RESULTS: The median age of the patients was 73.5 years. The longest follow-up duration was 502 days. A total of 113 cycles of treatment were given to 24 patients, and the median number of cycles was four (range, 1–14). Thirteen patients dropped out because of death, no or loss of response, patient refusal, or transfer to another hospital. Twenty-one (87.5%) and 12 (50%) patients completed the second and fourth cycles, respectively, and responses to treatment were evaluated in 17. A complete response (CR) or CR with incomplete blood-count recovery was achieved in six (35.3%) patients, and the estimated median overall survival was 502 days. Ten patients developed grade >2 hematologic or non-hematologic toxicities. In univariate analysis, bone marrow blasts, lactate dehydrogenase, serum ferritin level, and bone marrow iron were significantly associated with response to decitabine. CONCLUSION: Five-day decitabine treatment showed acceptable efficacy in older patients with AML who are unfit for conventional chemotherapy, with a CR rate 35.3% and about a median overall survival of 18 months.
Aged ; Antimetabolites, Antineoplastic/administration & dosage/*therapeutic use ; Azacitidine/*analogs & derivatives/therapeutic use ; DNA Methylation ; Female ; Humans ; Leukemia, Myeloid, Acute/*drug therapy/mortality ; Male ; Middle Aged ; Remission Induction ; Republic of Korea ; Retrospective Studies ; Treatment Outcome

Background/Aims: We aimed to define an optimal target population and drug-specific biomarkers that may predict dipeptidyl peptidase (DPP)-4 inhibitor responses in non-alcoholic fatty liver disease (NAFLD). Methods: An exploration study (study I) was performed using three different NAFLD models (basket study design; high-fat diet [HFD], methionine choline-deficient diet [MCD], and high-cholesterol Western diet [WD] models). RNA transcriptome analysis was performed on pre-studied liver tissues to identify biomarkers that could predict the response to DPP-4 inhibitors. In the validation study (study II), the HFD-induced NAFLD model was divided into high and low hepatic insulin-like growth factor binding protein 1 (Igfbp-1) groups based on the pre-study liver biopsy. Results: DPP-4 inhibitor attenuated the NAFLD activity score and fibrosis stage in the HFD model but not in the WD and MCD models. The overall response rate was 19% across the modified basket NAFLD trial and 42%, 25%, and 0% in the HFD, WD, and MCD models. Hepatic Igfbp-1 expression was higher in the responder group than in the non-responder group in pre-study biopsy samples. In contrast, hepatic Igfbp-1 expression was lower in the responder group than in the non-responder group in the end-study biopsy samples. DPP-4 inhibitor response rates were 83% and 17% in the baseline hepatic high Igfbp-1 and low Igfbp-1 groups, respectively. Hepatic messenger RNA Igfbp-1 expression was positively correlated with serum IGFBP-1 levels. Conclusions The DPP-4 inhibitor response was higher in the HFD phenotype and pre-treatment levels of hepatic or serum IGFBP-1 were high.

Mediastinal tuberculous lymphadenitis rarely mimics esophageal submucosal tumor, particularly in the case of multidrug-resistant tuberculosis (MDR-TB). Herein, we report the case of a 61-year-old woman who visited a local hospital complaining of odynophagia. An initial esophagogastroduodenoscopy revealed an esophageal submucosal tumor, and subsequent chest computed tomography showed subcarinal lymphadenopathy with an esophagomediastinal fistula. The patient was then referred to Samsung Medical Center, and a second esophagogastroduodenoscopy showed deep central ulceration, as well as a suspicious fistula in the esophageal submucosal tumor-like lesion. A biopsy examination of the ulcerative lesion confirmed focal inflammation only. Next, an endobronchial, ultrasound-guided lymph node biopsy was performed, and TB was confirmed. The patient initially began a course of isoniazid, rifampicin, ethambutol, and pyrazinamide. However, after a drug sensitivity test, she was diagnosed with MDR-TB, and second-line anti-TB medications were prescribed. She recovered well subsequently.
Biopsy ; Endoscopy, Digestive System ; Esophageal Fistula ; Ethambutol ; Female ; Fistula* ; Humans ; Inflammation ; Isoniazid ; Lymph Nodes ; Lymphadenitis* ; Lymphatic Diseases ; Middle Aged ; Pyrazinamide ; Rifampin ; Thorax ; Tuberculosis ; Tuberculosis, Lymph Node ; Tuberculosis, Multidrug-Resistant ; Ulcer

BACKGROUND/AIMS: Chronic liquid and/or food stasis caused by retention esophagitis (RE) in achalasia is a notable endoscopic finding because of the presence of a thickened or whitish esophageal mucosa and histologically altered squamous hyperplasia. We aimed to identify the clinical features of RE associated with achalasia and to clarify the clinical definition of RE in achalasia as a precancerous lesion identified by analyzing biomarker expressions. METHODS: From 2006 to 2015, we retrospectively reviewed 37 patients with achalasia without previous treatment. Among them, 21 patients had diagnostic findings of RE (RE+) and 16 patients had no diagnostic findings of RE (RE−). Immunohistochemical staining of p53, p16, and Ki-67 was performed on the endoscopic biopsy tissues from the patients with achalasia and 10 control patients with non-obstructive dysphagia. RESULTS: The symptom duration and transit delay were significantly longer in the RE+ group than in the RE− group. We found particularly high p53 positivity rates in the RE+ group (p<0.001). The rate of p16 expression was also significantly higher in the RE+ group than in the other two groups (p=0.003). CONCLUSIONS: A high p53 expression rate was more frequently found in the RE+ group than in the other two groups. RE could be a meaningful clinical feature of achalasia for predicting esophageal carcinogenesis.
Biopsy ; Carcinogenesis ; Deglutition Disorders ; Esophageal Achalasia* ; Esophageal Neoplasms* ; Esophagitis* ; Humans ; Hyperplasia ; Mucous Membrane ; Retrospective Studies ; Tumor Suppressor Protein p53