Objective To compare and evaluate fractional flow reserve (FFR) by intravenous infusion of adenosine 5’-triphosphate (ATP) through femoral veins and hand dosal veins. To find the feasibility of measuring FFR through ATP infusion at hand dosal veins. Methods A total of 27 patients receiving coronary angiography (CAG) were enrolled. FFR was measured by intravenous injection of ATP through femoral veins and hand dosal veins separately in 31 stenosed coronary arteries. Results A linear correlation between ATP infusion measuring FFR through femoral and hand dosal veins was observed. Heart rates, PR intervals and side effects were of no difference between the 2 routes of ATP infusion (P=0.79, P=0.56, P=0.85). It indicated that ATP infusion[160μg/(kg·min)]measuring FFR through hand dosal veins was compatable to which measuring FFR though femoral veins (y=0.945x+0.0043, R2=0.904, P=0.001). Compared with ATP infusion by femoral vein[from (53.7±15.8) s to (58.2±11.6) s], the time to FFR by infusion ATP measurement by hand dosal veins was longer[(48.7±17.9) s, P=0.015]. Conclusions The FFR measurement through ATP infusion at hand dosal veins has similar results with the FFR measured by femoral veins ATP infusion.

Objective To isolate HIV-specific T cell clone and to expand them in vitro through the activation-induced expression of CD137 molecule.Methods The peripheral blood mononuclear cells were isolated from HIV-infected patients and HIV Gag specific CD3+CD8+CD137+T cell subset were sorted to 96-well plate in 1 cell/well by multicolor flowcytometry and single cell sorting.After 14 days in vitro culture with feeder cells and cytokines, the numbers and phenotypes of the cultured HIV-specific T cells were calcu-lated and identified.Results The CD137 expression was low on rested T cells but up regulated by the stim-ulation with Gag peptide pool.The CD8+CD137+T cells could secret IFN-γ.The number of CD8 T cells reached to 106 after 14 days in culture and expanded to 107-108 cells after 28 days of culture in vitro 100%of the cells remained activated upon Gag stimulation.Conclusion In stead of using IFN-γ, CD137 could be utilized as a novel molecule to isolate and expand HIV specific T cells in vitro.The expanded antigen spe-cific T cell clones could maintain good activation status.

Objective To study the clinical efficacy of platelet-rich plasma (PRP) in the treatment of knee osteoarthritis (KOA) and evaluate whether the age,body mass index and grade of KOA are associated with the treatment outcomes.Methods Using the prospective,randomized,controlled study,100 KOA patients hospitalized between December 2013 and November 2014 were enrolled.Twentyeight patients were men and 72 were women.Mean age was 58 years (range,35-85 years).Degenerative arthritis occurred in 68 patients and traumatic arthritis in 32 patients.Kellgren-Lawrence (K-L) score was grade Ⅱ in 35 patients,grade Ⅱ in 46 and grade Ⅲ in 19.The patients were assigned to receive hyaluronic acid (HA) (HA group,n =50) and PRP (PRP group,n =50) by an intraarticular route once weekly for 3 weeks,according to the random number table.Between-group differences were insignificant in age,gender,body mass index (BMI) and K-L grade.Western Ontario and McMaster Universities Arthritis Index (WOMAC),visual analog scale (VAS) and cartilage lesions score (CaLs) were used for clinical and MRI evaluations.At follow-up evaluation,the effective rate was defined at least 36％ improvement from the baseline WOMAC score.Results All patients were followed up for 6 months.The effective rate in PRP group was 84％ versus 68％ in HA group after the last treatment (P ＞0.05),and was 60％ versus 36％ in HA group at the final follow-up (P ＜ 0.05).WOMAC score in both groups had significant improvement after operation,while VAS improved only in PRP group (P ＜ 0.01).In PRP group patients with K-L grade I had better VAS and WOMAC scores than those with grade Ⅱ (P ＜0.05),and patients with grade Ⅱ had better WOAMC score than those with grade Ⅲ (P ＜ 0.05).MRI findings showed seven patients in PRP group had similar CaLs before and after operation (P ＞ 0.05),and the area of abnormal signal in subchondral bone and the depth of cartilage lesion gradually decreased in one of them.Follow-up study showed the outcomes had negative correlation with age and K-L grade (P ＜0.05),but no certain correlation with BMI in PRP group (P ＞ 0.05).Clinical effects in both groups were decreased over time.Conclusions Intraarticular injection of PRP benefits to pain relief,decreased inflammation and tissue repair,and has much better outcome in patients with younger age and lower K-L grade.However,BMI is not associated with the outcome.

OBJECTIVETo study the influence of experimentally osteoporosis to osteogenic efficiency of bone matrix gelatin(BMG) implanted into the calvarial defects of rats.

METHODSSixty-eight female SD rats of 12 +/- 1 weeks were randomly divided into two groups with 34 rats in each group. The ovaries were excised in the ovariectomized group (VG). The control group underwent sham surgery. Ninety days after ovariectomy, 10 rats from each group were examined to ensure the formation of postmenopausal osteoporosis by measuring bone density of the femur with single photon absorptiometric measurements. A critical-sized (8 mm in diameter) calvarial defect was created on the rest of 48 rats. Bone matrix gelatin was implanted to the defect. The rats were scarified at the 21st and 56th day after surgery respectively. The new bone forming capability of BMG was evaluated with undecalcified histological observation, tetracycline fluorescence marker, quantitative bone histomorphometry, At 90th day after ovariectomy, bone density of scanning electron microscopy and X-ray spectrometry.

RESULTSOVG showed very significant difference compared with the control group (0.315 +/-.015) g/cm2 vs [(0.347 +/- 0.017) g/cm2, P < 0.01 ]. At the 21st day following the implantation operation, new bone formed within the bone defects in both groups. The amount of new bone in OVG was lower than the control group. The tetracycline-labeled region in the bone defect was sparser in the OVG. At the 56th day, the bone defects healed mostly in the control group but fibrous tissue filled parts of bone defect in the OVG. The distance between two fluorescent lines of incorporated tetracycline and the mean mineralization deposition were significantly lower in the OVG than the control at the 21st day and 56th day. Mineralization of callus in OVG was inferior. Significant difference was found between the OVG and the control group in the calcium to phosphate ratio of callus in bone defects at the two time-points.

CONCLUSIONSExperimentally induced osteoporosis depressed osteogenic efficiency of BMG, suggesting that estrogen could play an important role in bone remodeling with bone substitute participating.

Animals ; Bone Matrix ; chemistry ; Bone Regeneration ; Female ; Femur ; metabolism ; Gelatin ; therapeutic use ; Osteogenesis ; Osteoporosis ; surgery ; Ovariectomy ; Rats ; Rats, Sprague-Dawley ; Skull Fractures ; surgery

Background: In the face of the unexpected coronavirus disease 2019 (COVID-19) pandemic, every country has struggled with insufficient human resources and medical supplies. This study aims to provide the statistical information necessary for discussing how to model stockpiles of medical resources. Methods: This study was conducted at the Hallym University Kangnam Sacred Heart Hospital, in South Korea. The study duration was 2 weeks, centered on March 16, 2022, when the number of daily confirmed patients with COVID-19 in Korea peaked. The number of human resources was obtained by counting the number of healthcare workers using CCTV. Drug prescriptions and medical device usage were obtained from electronic medical records. Results: In total, 117 inpatients and 26,485 outpatients were managed at this hospital during the 2-week study period. Daily visits were highest among nurses in all units, followed by doctors and radiology technicians. The mean daily consumption of personal protective equipment (PPE) per bed was 4.3 sets in the intensive care unit (ICU), 1.8 in the semi-ICU, and 1.4 in the ward. Despite the four-fold difference in the number of patients, there was no statistically significant difference between the two wards in the number of daily visits. Drug prescription rates were higher among inpatients than at-home patients. Conclusions The higher the COVID-19 severity, the higher the consumption of PPE per patient. Among healthcare workers, nurses had the highest number of inpatient treatment visits for COVID-19. To efficiently utilize, PPE, structures containing more isolation beds in a single negative pressure isolation system would be preferred.

Although congenital syphilis can be prevented with prenatal screening, the disease remains problematic. Currently, there are no cases that describe hematuria and pneumonia related to congenital syphilis. We report a case of congenital syphilis that involved nephrotic syndrome and pneumonia alba in a 22-day-old male infant whose mother did not receive adequate prenatal care. The congenital syphilis diagnosis was confirmed with a serologic test and the patient recovered with penicillin treatment. Clinical findings may be subtle in neonates and delayed recognition occurs frequently, thus complete prenatal screening is critical for congenital syphilis prevention. Immediate serologic testing should be performed to obtain a differential diagnosis if an infant is delivered by a mother that has not received appropriate prenatal examinations.
Diagnosis ; Diagnosis, Differential ; Exanthema* ; Hematuria* ; Humans ; Infant ; Infant, Newborn ; Male ; Mothers ; Nephrotic Syndrome ; Penicillins ; Pneumonia* ; Prenatal Care ; Prenatal Diagnosis ; Serologic Tests ; Syphilis, Congenital*

PURPOSE: To determine the CT findings which distinguish consolidation-type bronchioloalveolar carcinoma fromnecrotizing pneumonia. MATERIALS AND METHOD: This study involved ten patients with pathologically-provenconsolidation-type bronchioloalveolar carcinoma and 34 with necrotizing pneumonia proven pathologically either inthe laboratory or clinically. We retrospectively analyzed CT features including the enhancement pattern ofconsolidated lung, the presence and internal density of cavity within consolidated lung, CT angiogram sign,air-bronchogram, pleural enhancement, pleural effusion, and change in extrapleural tissue and its density. RESULT: CT findings in patients with necrotizing pneumonia showed higher attenuation in marginal (94.1%) and inner(85.3%) portions in consolidated lung than in muscles (p<0.005); the presence of cavity (91.2%, p<0.05) ; cavitywith fluid or air-fluid level (77.4%, p<0.005); pleural enhancement (88.2%, p<0.00003) ; pleural effusion (33.3%,p<0.05); and change in extrapleural tissue (64.7%, p<0.05). CT findings in patients with consolidation-typebronchioloalveolar carcinoma showed lower attenuation in marginal (90.0%) and inner (60.0%) portions ofconsolidated lung than muscles (p<0.005) and of cavity containing air (100%; p<0.005). However, air-bronchogramand CT angiogram signs were not helpful in differentiating the two groups. CONCLUSION: CT can help differentiateconsolidation-type bronchioloalveolar carcinoma and necrotizing pneumonia.
Adenocarcinoma, Bronchiolo-Alveolar* ; Diagnosis, Differential* ; Humans ; Lung ; Muscles ; Pleural Effusion ; Pneumonia* ; Retrospective Studies

Langerhans cell histiocytosis(LCH) is a systemic disorder characterized by idiopathic proliferation of histiocytes in the reticuloendothelial system; CNS involvement outside the hypothalamus or pituitary gland is uncommon. We present a case of LCH involving the brainstem, cerebellum, and temporal lobes, and also showing hypothalamic involvement. The lesions were isointense or hypointense on T1WI and hyperintense on T2WI, and showed multifocal enhancing nodules on post-contrast CT and Gd-enhanced MRI.
Brain Stem ; Central Nervous System* ; Cerebellum ; Histiocytes ; Histiocytosis ; Histiocytosis, Langerhans-Cell* ; Hypothalamus ; Magnetic Resonance Imaging ; Mononuclear Phagocyte System ; Pituitary Gland ; Temporal Lobe

PURPOSE: To assess the changes of corneal astigmatism and higher order aberrations (HOAs) of the anterior and posterior corneal surface after cataract surgery with on-axis clear corneal incision in eyes with-the-rule (WTR) astigmatism and against-the-rule (ATR) astigmatism. METHODS: This study included 50 patients who underwent phacoemulsification and IOL insertion through a 2.8-mm on-axis clear corneal incision. The eyes were divided into two groups: (1) 26 eyes with WTR astigmatism with a superior incision and (2) 24 eyes with ATR astigmatism with a temporal incision. During the follow-up period, visual acuity was measured, and the surgically induced astigmatism (SIA) and HOAs of the anterior and posterior corneal surface were measured with Pentacam(R) (Occlus, Wetzlar, Germany) preoperatively and 1 week, 1 month, and 2 months postoperatively. RESULTS: There were no significant differences in UCVA and BCVA between the two groups. HOAs increased in both groups 1 week after surgery, but no significant differences were found between the groups (p > 0.05). Surgically induced astigmatism was larger in the WTR group than in the ATR group (p < 0.05). At postoperative 2 months, there were significant differences in HOAs between the two groups, and there were statistically significant differences in HOAs, oblique trefoil at front side, and in HOAs, horizontal coma at rear side (p < 0.05). CONCLUSIONS: In conclusion, superior incision in eyes with WTR astigmatism resulted in higher SIA compared to temporal incision in eyes with ATR astigmatism. Moreover, HOAs was significantly decreased in eyes with WTR astigmatism with superior incision. Thus, superior incision could be more effective in reducing corneal astigmatism in eyes with WTR astigmatism.
Astigmatism* ; Cataract* ; Coma ; Follow-Up Studies ; Humans ; Lotus ; Phacoemulsification ; Visual Acuity

Objective: To identify the clinical characteristics of patients with myasthenia gravis (MG) according to age at onset. Methods: We retrospectively recruited 227 non-thymomatous MG patients with adult onset who had been followed up for more than one year. The patients were classified based on the age of symptom onset as “early-onset MG” (EOMG,18–50 years; N=135), “late-onset MG” (LOMG, 50–64 years; N=53), and “very late-onset MG” (VLOMG, 65 years; N=39). Clinical features and serological findings were compared between these groups. Results: LOMG patients showed more frequent ocular MG (55%) and less frequent thymic hyperplasia (9%) compared to EOMG patients (31% and 38%; p=0.006 and p<0.001, respectively), and no female preponderance compared to VLOMG patients (female, 49% vs.77%; p=0.014). However, there were no significant differences between VLOMG and EOMG patients, except for more frequent thymic hyperplasia (p<0.001) in EOMG patients. When analyzing female patients only, less frequent secondary generalization (10%) were additionally found in LOMG patients, compared to EOMG (47%, p= 0.008) and VLOMG (59%, p=0.004) patients. Anti-acetylcholine receptor antibody (HR, 5.48; 95% CI, 1.73–17.37; p=0.004) was independently associated with secondary generalization in female EOMG patients. Conclusion: Our study suggests that LOMG patients, especially female, were characterized by frequent ocular MG and less frequent secondary generalization, distinguished from EOMG and VLOMG patients. Further large epidemiologic studies in Korea are needed to determine the characteristics of MG patients according to the age at onset and gender.