BACKGROUND: Bile cultures have been used to diagnose and predict the prognosis of acute cholecystitis (AC). As the standard treatment for AC has changed, the appropriate timing and clinical usefulness of bile cultures should be reevaluated. We analyzed the incidence of positive bile cultures in cholecystostomy and cholecystectomy, and attempted to see if a positive bile culture is related to the laboratory and imaging parameters and postoperative infections. METHODS: Included in the study were 86 patients with AC who underwent percutaneous cholecystostomy (PC) and then laparoscopic cholecystectomy (LC). We performed hematologic, biochemical, and radiological analyses at admission and bile cultures with each surgical procedure. The patients were followed for two months for postoperative infections. RESULTS: Bile cultures were positive in 40.7% of the patients at PC, significantly higher than at LC (12.8%). The group with positive cultures showed a higher median age and elevated levels of alkaline phosphatase (ALP) and total bilirubin (TB) than the group with negative cultures. Univariate analysis identified three preoperative factors as predictors of positive bile cultures: age (>55 yr), ALP (>100 IU/L) and TB (>1.2 mg/dL). Infectious complications after LC were mild and the incidence of postoperative infections was not different between the groups. CONCLUSIONS: The sensitivity of bile cultures is low for diagnosing AC, and the adequate timing of bile cultures is at PC, rather than LC. An old age and factors (ALP & TB) manifesting an advanced stage of bile stasis are associated with positive bile cultures. No correlation was found between positive bile cultures and postoperative infections.
Adult ; Aged ; Aged, 80 and over ; Bacterial Infections/*diagnosis ; Bile/*microbiology ; *Cholecystectomy, Laparoscopic/methods ; Cholecystitis, Acute/complications/*surgery ; *Cholecystostomy/methods ; Culture Techniques ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications/*diagnosis ; Predictive Value of Tests

BACKGROUND: Bile cultures have been used to diagnose and predict the prognosis of acute cholecystitis (AC). As the standard treatment for AC has changed, the appropriate timing and clinical usefulness of bile cultures should be reevaluated. We analyzed the incidence of positive bile cultures in cholecystostomy and cholecystectomy, and attempted to see if a positive bile culture is related to the laboratory and imaging parameters and postoperative infections. METHODS: Included in the study were 86 patients with AC who underwent percutaneous cholecystostomy (PC) and then laparoscopic cholecystectomy (LC). We performed hematologic, biochemical, and radiological analyses at admission and bile cultures with each surgical procedure. The patients were followed for two months for postoperative infections. RESULTS: Bile cultures were positive in 40.7% of the patients at PC, significantly higher than at LC (12.8%). The group with positive cultures showed a higher median age and elevated levels of alkaline phosphatase (ALP) and total bilirubin (TB) than the group with negative cultures. Univariate analysis identified three preoperative factors as predictors of positive bile cultures: age (>55 yr), ALP (>100 IU/L) and TB (>1.2 mg/dL). Infectious complications after LC were mild and the incidence of postoperative infections was not different between the groups. CONCLUSIONS: The sensitivity of bile cultures is low for diagnosing AC, and the adequate timing of bile cultures is at PC, rather than LC. An old age and factors (ALP & TB) manifesting an advanced stage of bile stasis are associated with positive bile cultures. No correlation was found between positive bile cultures and postoperative infections.
Adult ; Aged ; Aged, 80 and over ; Bacterial Infections/*diagnosis ; Bile/*microbiology ; *Cholecystectomy, Laparoscopic/methods ; Cholecystitis, Acute/complications/*surgery ; *Cholecystostomy/methods ; Culture Techniques ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications/*diagnosis ; Predictive Value of Tests

BACKGROUND: Hepcidin plays a central role in the regulation of iron metabolism, and hepatic iron production is stimulated by iron load and inflammation. Recent animal studies have shown that hepcidin levels increase when hematopoiesis is blocked. We aimed to monitor pre- and post-stem cell transplantation hepcidin levels and evaluate its association with hematologic recovery. METHODS: The study group comprised 12 patients with hematologic malignancies (7 with AML, 4 with ALL, and 1 with refractory anemia with excess blasts-2) undergoing allogeneic peripheral blood stem cell transplantation (PBSCT). One day before and 3 days, 1 week, 2 weeks, 4 weeks, and 8 weeks after PBSCT, reticulocyte count and levels of Hb, ferritin, and C-reactive protein were monitored; serum hepcidin-25 was measured by ELISA. RESULTS: The median serum hepcidin-25 levels (ng/mL) were significantly higher until 1 week after PBSCT (103.6, 103.3, and 96.5) than those at 2, 4, and 8 weeks after PBSCT (63.9, 53.9, and 56.6, respectively). The reticulocyte count also significantly increased from 2 weeks after PBSCT. The hepcidin level showed an inverse correlation with reticulocyte count (r=-0.56, P<0.001) and a weak positive correlation with ferritin (r=0.27, P=0.02). At 2 weeks, patients with high hepcidin levels (> or =63.9) tended to demonstrate lower Hb recovery at 8 weeks than patients with low hepcidin levels did (P=0.15), but without any differences in the incidence of complications. CONCLUSIONS: These findings indicate that hepcidin production is associated with erythropoietic activity and that hepcidin level may be used as an early marker of hematopoietic recovery in PBSCT.
Anemia, Refractory ; Animals ; Antimicrobial Cationic Peptides ; C-Reactive Protein ; Cell Transplantation ; Ferritins ; Hematologic Neoplasms ; Hematopoiesis ; Humans ; Incidence ; Inflammation ; Iron ; Organothiophosphorus Compounds ; Peripheral Blood Stem Cell Transplantation ; Reticulocyte Count ; Stem Cell Transplantation ; Transplants

Diagnostic hematology subcommitee of The Korean Association of Quality Assurance for Clinical Laboratory performed laboratory proficiency testing for blood cell count, cell morphology and coagulation tests in 2013. Four trials for blood cell count and cell morphology and 2 trials for coagulation tests were executed. Average 1,308, 494, and 558 laboratories participated in the surveys of blood cell count, cell morphology and coagulation tests, respectively. The overall reply rates were 95.78%, 97.75%, and 97.38%, respectively. The homogeneity of external quality materials was stable (less than 3%) and status of use of the instrument and reagents was similar to those of the previous year. The CVs in white blood cell count, red blood cell count, platelet count, hemoglobin, and hematocrit were 3.15%, 2.00%, 5.10%, 1.81%, and 2.71%, respectively. For cell morphology, most showed concordant rate >80%. CVs of coagulation tests showed difference depending on instruments or reagent groups. An educational workshop on hands-on experience in diagnostic hematology was held in July. In 2013, the number of participating laboratories is more increased and the performance of surveys of hematology tests is similar performance compared to previous year. In addition, the revision in the way of evaluation of coagulation tests is needed.
Blood Cell Count ; Education ; Erythrocyte Count ; Hematocrit ; Hematology* ; Indicators and Reagents ; Korea ; Laboratory Proficiency Testing ; Leukocyte Count ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time

During 2014, the Diagnostic Hematology Subcommittee of the Korean Association of Quality Assurance for Clinical Laboratories performed laboratory proficiency testing for blood cell count, cell morphology, and coagulation tests. Four trials for blood cell count and cell morphology tests and 2 trials for coagulation tests were performed. The trials for blood cell counts had a reply rate of 96.8% among 1,343 laboratories, compared to 99.3% among 489 laboratories for cell morphology and 98.6% among 565 laboratories for coagulation tests. The homogeneity of the external quality materials was stable (<3%), and the use of instruments and reagents was similar to that observed during the previous year. The CVs for white blood cell counts, red blood cell counts, platelet counts, hemoglobin tests, and hematocrit tests were 4.46%, 2.12%, 2.21%, 5.08%, and 8.31%, respectively. For cell morphology tests, concordant rates were >80% for most of the participating laboratories. The CVs for the coagulation tests varied according to the specific instruments or reagents that were used. An educational workshop was held in July to provide hands-on experience in diagnostic hematology. During 2014, the number of participating laboratories was increased, while the performance of hematology tests was similar to that observed in the previous year.
Blood Cell Count ; Education ; Erythrocyte Count ; Hematocrit ; Hematology* ; Indicators and Reagents ; Korea ; Laboratory Proficiency Testing ; Leukocyte Count ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time

BACKGROUND: Hepcidin has recently been known as a negative regulatory hormone of iron. Hepcidin precursor, pro-hepcidin has been used as a surrogate and reported to be related to iron deficiency. We investigated serum pro-hepcidin levels in patients with iron deficiency anemia (IDA), anemia of chronic disorder (ACD) and ACD concomitant iron deficiency (ACD/ID) to assess its usefulness as a marker of iron deficiency and examined whether its level is associated with anemia, iron status or inflammation profiles involved in the synthesis of hepcidin. METHODS: We enrolled 50 patients with IDA, 46 with ACD, 12 with ACD/ID and 60 healthy controls. Complete blood cell count, iron parameters (iron, TIBC, trasferrin saturation, ferritin), C-reactive protein (CRP) and serum pro-hepcidin were measured. RESULTS: Patients with iron deficiency, the IDA group and ACD/ID group had lower serum pro-hepcidin levels than healthy controls and the ACD group. The cutoff value of pro-hepcidin for detecting iron deficiency was 230 ng/mL (sensitivity 88.1%, specificity 51.2%). Patients with increased CRP showed higher mean pro-hepcidin level than those with normal CRP and the difference was significant in the IDA group (P=0.02). And serum pro-hepcidin level was positively correlated with CRP level (r=0.30, P=0.04) in the IDA group but not with hemoglobin. CONCLUSIONS: In patients with anemia, pro-hepcidin measurement may be useful for differentiating anemia patients with iron deficiency, IDA and ACD/ID from those with ACD. Serum pro-hepcidin levels may be more affected by inflammation than by the degree of anemia.
Anemia ; Anemia, Iron-Deficiency ; Antimicrobial Cationic Peptides ; Blood Cell Count ; C-Reactive Protein ; Humans ; Inflammation ; Iron ; Protein Precursors ; Sensitivity and Specificity

BACKGROUND: Dual antiplatelet therapy (aspirin and clopidogrel) is used to prevent adverse cardiac events in patients undergoing percutaneous coronary intervention (PCI). Some patients do not respond adequately to clopidogrel. Beta-thromboglobulin (beta-TG) and platelet factor 4 (PF-4) can act as markers to detect platelet activation. We investigated the relationship between clopidogrel response and the dynamics of beta-TG and PF4 concentrations. METHODS: This study included 36 myocardial infarction (MI) patients, who underwent PCI and was indicated for dual antiplatelet therapy. Platelet reactivity, using the VerifyNow P2Y12 assay, was measured on the 3rd day of PCI. At the time of admission, and on the 3rd and 10th day of PCI, the plasma beta-TG and PF4 concentrations were quantified. RESULTS: Ten patients (27.8%) were clopidogrel non-responders displaying >208 P2Y12 reaction units. At the time of admission, levels of beta-TG in patients were elevated than that in the healthy controls (P<0.001). A similar trend was observed on the 3rd and 10th day of PCI (P<0.001). The beta-TG levels on the 10th day were reduced than those at the time of admission and on the 3rd day of PCI. PF4 levels were not different between patients and controls, and were not significantly reduced after PCI. Higher beta-TG levels were observed in clopidogrel non-responders on the 10th day, but not significant. CONCLUSIONS: Clopidogrel therapy in MI reduce beta-TG concentration, but the beta-TG and PF4 levels before and after therapy are not associated with the response to clopidogrel. Platelet-derived markers may not be suitable for distinguishing clopidogrel non-responders.
beta-Thromboglobulin ; Blood Platelets* ; Humans ; Infarction* ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Plasma ; Platelet Activation* ; Platelet Factor 4

During 2015, the Diagnostic Hematology Subcommittee of Korean Association of External Quality Assessment Service performed laboratory proficiency testing for blood cell count, cell morphology, and coagulation tests. Four trials for blood cell count and cell morphology tests each and two trials for coagulation tests were performed. The trials for blood cell counts had a reply rate of 97.2% among 1,352 laboratories, compared to 99.0% among 503 laboratories for cell morphology and 98.6% among 574 laboratories for coagulation tests. The homogeneity of the external quality materials was stable (<3%), and the use of instruments and reagents was similar to that observed during the previous year. The coefficients of variation (CVs) for white blood cell counts, red blood cell counts, platelet counts, hemoglobin tests, and hematocrit tests were 4.13%, 1.89%, 1.92%, 5.02%, and 8.10%, respectively. For cell morphology tests, concordant rates were >80% for most of the participating laboratories. The CVs for the coagulation tests varied according to the specific instruments or reagents that were used. An educational workshop was held in November to provide hands-on experience in diagnostic hematology. During 2015, the number of participating laboratories increased, while the performance of hematology tests was similar to that observed in the previous year.
Blood Cell Count ; Education ; Erythrocyte Count ; Hematocrit ; Hematology* ; Indicators and Reagents ; Korea* ; Laboratory Proficiency Testing ; Leukocyte Count ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time

Quadrivalent human papillomavirus (HPV) vaccine has been reported to be significantly associated with Behçet's disease (BD). However, no reports have described HPV infection as a possible cause for the development of BD. The objective of this study was to evaluate whether anti-HPV immunoglobulin G (IgG) antibody titer is increased in BD. Serum samples from 93 Korean BD patients, who fulfilled the diagnostic criteria of the International Study Group for BD, were used in an enzyme-linked immunosorbent assay (ELISA). The clinical activity of BD was evaluated at the time of blood sampling. HPV-16 L1 virus-like particle (VLP) antigen was used in this study for the ELISA. Patients with BD had significantly higher antibody titers against HPV-16 (optical density [OD], 0.210–3.675; mean 0.992) than that of healthy controls (OD, 0.248–0.762; mean 0.517; P < 0.001). Using a receiver operating characteristic (ROC) analysis, a cut-off value of 0.578 OD for the anti-HPV antibody titer was determined that differentiated BD patients from healthy controls. When we compared the clinical features of BD between the 2 groups, articular involvement of BD was more likely in patients with an anti-HPV-16 antibody titer < 0.578 OD (P = 0.035). In addition, patients with an anti-HPV-16 antibody titer < 0.578 were significantly younger than those with a titer ≥ 0.578 OD. HPV itself may be a possible extrinsic triggering infectious agent causing the development of BD.

BACKGROUND: For creatinine measurement, the enzymatic method is known to be more accurate than the Jaffe method; however, the latter is still widely used. We evaluated the performance of the CRE2 reagent (Siemens Healthcare Diagnostics Inc., USA), which uses a modified Jaffe method. METHODS: Three quality control standards were used for precision evaluations of CRE2 on Dimension VISTA 500 instrument (Siemens). Moreover, the linearity and carryover characteristics were assessed. Sixty-eight creatinine results obtained using the CRE2 and ECREA (enzymatic) reagents (Siemens) were compared with those obtained using the L-CRE (enzymatic) reagent (Shinyang Diagnostics, Korea). The accuracy of CRE2, ECREA, and L-CRE was evaluated using a standard reference material. RESULTS: The CV of within-run (0.7–2.4%), between-run (0.4–1.7%), between-day precision (0.7–0.9%) for three standards, and total CV for medium (1.6%) and high levels (1.3%) satisfied the analytical goal. The linearity for CRE2 was excellent (R2=0.999). Comparisons of CRE2 and ECREA to L-CRE were well correlated (r=0.996 and 0.997, respectively). In comparison with L-CRE, 5 CRE2 results and 15 ECREA results exceeded minimum bias goal (5.1%) in samples with creatinine levels of >1 mg/dL. The carryover rate was −0.04%. In terms of accuracy, the percent bias values of CRE2, ECREA, and L-CRE were 7.4, −6.4, and −3.4, respectively, for low level; and 3.9, −1.5, and 0.7, respectively, for high level. CONCLUSIONS: For creatinine measurements, the CRE2 reagent showed good performance. It can be used in the diagnosis, treatment monitoring, and risk assessment of kidney diseases.
Bias (Epidemiology) ; Creatinine* ; Delivery of Health Care ; Diagnosis ; Indicators and Reagents ; Kidney Diseases ; Methods ; Quality Control ; Risk Assessment