PURPOSE: The cross-protection of 7-valent pneumococcal conjugate vaccine (PCV7) against vaccine-related serotypes has been controversial. We investigated the serological properties of cross-protective antibodies against vaccine-related serotypes 6A, 6C, and 19A induced in young children aged 12-23 months after booster immunization of PCV7. METHODS: IgG and IgM antibody concentrations and opsonic index (OI) against vaccine serotypes 6B and 19F and vaccine-related serotypes 6A, 6C, and 19A were measured by ELISA and opsonophagocytic killing assay (OPA) in 4 selected immunesera. The serological properties and antigenic specificity of protective antibodies were determined by IgM depletion of immunesera, OPA, and competitive OPA against serogroup 6 and 19 pneumococci. RESULTS: Compared to pre-IgM depleted immunesera, OI of IgM-depleted immunesera against 6B and 19F decreased and OI against 6A, 6C, and 19A decreased, too. In competition OPA, free 6B and 19F polysaccharide completely inhibited the immune protection against vaccine-related serotypes 6A, 6C, and 19A as well as vaccine types 6B and 19F. CONCLUSIONS: The booster immunization of PCV7 certainly induced cross-protective antibodies against vaccine-related serotypes 6A, 6C, and 19A with both IgG and IgM isotypes. Furthermore, IgM antibodies are more highly contributed to opsonophagocytic activity against vaccine-related serotypes as well as most of vaccine types than do IgG antibodies. Further studies are needed for the more immunized sera in the children as well as adults.
Adult ; Aged ; Antibodies ; Child ; Cross Protection ; Enzyme-Linked Immunosorbent Assay ; Epitopes ; Homicide ; Humans ; Immunization ; Immunization, Secondary ; Immunoglobulin G ; Immunoglobulin M ; Pneumococcal Vaccines ; Streptococcus pneumoniae ; Heptavalent Pneumococcal Conjugate Vaccine

The kidney size is of special interest during the diagnostic work up of acute lymphocytic leukemia. But is still uncertain whether a finding of kidney enlargement at presentation has long-term prognostic value. We therefore reviewed the kidney size in children with acute lymphocytic leukemia by abdominal ultrasonograms at the time of diagnosis (n=54) and exmined if there was any statistical significance between the kidney size and prognostic parameters and later outcome. The following results were obtained 1) Among the patients whose kidney size was enlarged over 4SD from the normal, hepatomegaly in 3 cases (20%), splenomegaly in 3 cases (20%), mediastinal widening in 2 cases (13%) were noted. The interrelation between kidney size and infiltration of extramedullary system had no statistical significance. 2) Among the patients whose kidney size was enlarged over 4SD from the normal, patients under age 2 and over age 10 in 5 cases (33%), male in 8 cases (53%), involvement of central nervous system in 1 cases (7%), WBC count over 100x10E9/L in 3 cases (20%), Hb over 10 g/dl in 3 cases (20%) and platelet count below 100x10E9/L in 3 cases (20%) were noted. There was no statistical significance between kidney size and infiltration of extramedullary system. 3) Two Year survival rate based upon kidney size was; 95% in the group below 2SD, 79% between 2SD and 4SD, 59% over 4SD. And 2 Year event free survival rate was 71%, 56% and 58 respectively. In conclusion, the kidney size in childhood acute lymphocytic leukemia at the time of diagnosis influences the late outcome, but it is not a meaningful prognostic parameters.
Central Nervous System ; Child ; Diagnosis ; Disease-Free Survival ; Hepatomegaly ; Humans ; Kidney ; Male ; Platelet Count ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Splenomegaly ; Survival Rate ; Ultrasonography

BACKGROUND: In general, the outcomes of arthroscopic repair for superior labrum anterior to posterior lesions (SLAP) are favorable, however, persistent pain and limitation of motion are not rare complications. One of the possible cause is a “knot-ache”. This study evaluated the results of reoperation of symptomatic recurrent SLAP lesions and asked whether the knot is associated with postoperative complications. METHODS: Between 2005 and 2015, a total of 11 patients who had undergone arthroscopic SLAP repair were reoperated for recurrent symptomatic SLAP lesion. By retrospective chart review, operative findings, the visual analogue scale for pain (pVAS), the range of motion (ROM), and functional scores were analyzed. RESULTS: The mean age of the study participants was 38.3 years, and the mean follow-up period was 42.5 months. In the primary operation, there were nine cases of repairs with conventional knot-tying anchors and three cases with knotless anchors. Impingement of the knots during abduction and external rotation of the shoulder was observed in the all cases with knot-tying anchors. The mean pVAS, ROM, and functional scores significantly improved with reoperation. At the final follow-up, the mean satisfaction VAS was 8.3. CONCLUSIONS: The knots of suture anchor maybe a possible etiology of the pain, which we termed a “knot-ache”. Considering that reoperation is performed due to pain after primary repair, the use of knotless suture anchor may have benefits of eliminating one of possible cause, “knot-ache”. Therefore, authors suggest the use of knotless anchors during reoperation for recurrent or recalcitrant pain after primary SLAP repair.

Prostate cancer has long been considered a disease with a heterogeneous phenotype. The intratumor heterogeneity (ITH) may affect diverse phenotypes such as treatment response, drug resistance, and overall clinical outcomes. Despite technical advances over the past decade, we have an incomplete understanding of the extent and effects of ITH in prostate cancer progression. We present here a comprehensive review of the various studies dealing with ITH in prostate cancer. We discuss the advanced next-generation sequencing analyses including single cell sequencing and circulating cell-free DNA sequencing that have the impact of heterogeneity on clinical decision making.

Prostate cancer has long been considered a disease with a heterogeneous phenotype. The intratumor heterogeneity (ITH) may affect diverse phenotypes such as treatment response, drug resistance, and overall clinical outcomes. Despite technical advances over the past decade, we have an incomplete understanding of the extent and effects of ITH in prostate cancer progression. We present here a comprehensive review of the various studies dealing with ITH in prostate cancer. We discuss the advanced next-generation sequencing analyses including single cell sequencing and circulating cell-free DNA sequencing that have the impact of heterogeneity on clinical decision making.

BACKGROUND: Apoptosis plays a role in the development of pleural effusion. Caspase-cleaved cytokeratin 18, a marker for epithelial cell apoptosis, was evaluated in pleural effusion. METHODS: A total of 79 patients with pleural effusion were enrolled. The underlying causes were lung cancer (n=24), parapneumonic effusion (n=15), tuberculous effusion (n=28), and transudates (n=12). The levels of M30, an epitope of caspase-cleaved cytokeratin 18, were measured in blood and pleural fluids using enzyme-linked immunosorbent assay along with routine cellular and biochemical parameters. The expression of M30 was evaluated in the pleural tissues using immunohistochemistry for M30. RESULTS: The M30 levels in pleural fluid were significantly higher in patients with tuberculosis (2,632.1+/-1,467.3 U/mL) than in patients with lung cancer (956.5+/-618.5 U/mL), parapneumonic effusion (689.9+/-413.6 U/mL), and transudates (273.6+/-144.5 U/mL; all p<0.01). The serum levels were not significantly different among the disease groups. Based on receiver operating characteristics analysis, the area under the curve of M30 for differentiating tuberculous pleural effusion from all other effusions was 0.93. In the immunohistochemical analysis of M30, all pathologic types of cancer cells showed moderate to high expression, and the epithelioid cells in granulomas showed high expression in tuberculous pleural tissues. CONCLUSION: Caspase-cleaved cytokeratin 18 was most prominently observed in tuberculous pleural effusion and showed utility as a clinical marker. The main source of M30 was found to be the epithelioid cells of granulomas in tuberculous pleural tissues.
Apoptosis ; Biomarkers ; Cytoskeleton ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells ; Epithelioid Cells ; Exudates and Transudates ; Granuloma ; Humans ; Immunohistochemistry ; Keratin-18* ; Keratins* ; Lung Neoplasms ; Pleural Effusion* ; ROC Curve ; Tuberculosis ; Tuberculosis, Pleural

To determine the long-term results after PMV, the incidence of restenosis and analysis the factors predicting restenosis, 108 patients were studied at pre-, post-PMV, after 3 months and 1 year (13+/-4 months) with echocardiography. 1) Restenosis was demonstrated in 25 of 108 patients(23%) at 1 year follow-up. 2) Descriminant analysis showed echocardiographic score and mitral valve area before PMV as predictors of restenosis. 3) There were significant decreament of mitral valve area from 1.8+/-0.4cm2 (after PMV) to 1.5+/-0.3 cm2 at 3 months follow-up and further stenosis (1.2+/-0.3 cm2) at long-term follow-up in group with restenosis. In contrast, in group without restenosis, mitral valve area after PMV was 1.8+/-0.3cm2, aat 3 months follow-up was 1.8+/-0.3cm2 and at long term follow-up was 1.8+/-0.4cm2. 4) There was higher restenosis rate in group with Inoue balloon (47%) than group with double balloon (18%) despite of large EBDA/BSA.
Constriction, Pathologic ; Echocardiography ; Follow-Up Studies* ; Humans ; Incidence ; Mitral Valve

BACKGROUND: Geriatric patients undergoing artificial joint replacement have increased not only in numbers but in age over the past years. These patients usually have accompanying comorbidities which may be increased by age itself and these comorbidities increases clinical challenge while undergoing anesthesia. METHODS: Raw data from 1992 to 2006 undergoing artificial joint replacement were collected and investigated retrospectively. Five-year periods of interest (POI) were created for analysis. POI I is five-year periods of interest from 1992 to 1996, POI II from 1997 to 2001 and POI III from 2002 to 2006. Changes in demographic variables and prevalence of a variety of comorbidities were statistically evaluated. RESULTS: We identified 4,196 patients in whom artificial joint replacement was performed between 1992 and 2006. Of those, 805, 1,212 and 2,179 were performed in POI I, POI II and POI III, respectively. The average age and the prevalence of hypertension and diabetes mellitus increased significantly. CONCLUSIONS: The prevalence of comorbid diseases among the patients undergoing artificial joint replacement has increased significantly for hypertension and diabetes mellitus. Also increase in average age of patients undergoing surgery as well as accompanying comorbidities pose an increased clinical challenge. A thorough preanesthetic evaluation and optimal anesthetic technique is necessary to decrease the morbidity and mortality in geriatric patients undergoing artificial joint replacement on the lower extremities.
Anesthesia ; Arthroplasty ; Comorbidity ; Diabetes Mellitus ; Humans ; Hypertension ; Joints ; Lower Extremity ; Prevalence ; Retrospective Studies

Testicular adrenal rest tumors are a well-known complication in male patients with congenital adrenal hyperplasia. Corticosteroid suppressive therapy usually results in the regression of these tumors. We describe a patient with 21-hydroxylase deficiency who developed bilateral testicular masses. Despite steroid suppressive therapy, the tumors did not regress and hormonal control was poor. Consequently, bilateral partial orchiectomies were performed.
Adrenal Hyperplasia, Congenital ; Adrenal Rest Tumor ; Child ; Humans ; Male ; Orchiectomy ; Steroid 21-Hydroxylase ; Testicular Neoplasms

BACKGOUND: Pulsed dye laser (PDL) is recommended as a good treatment for scars and keloids. However, there has been no absolute indications and standard laser parameters. Some proposed that only hypertrophic and atrophic/flat scars were effectively treated, but others reported that all scars and even keloids responded well to PDL treatment. OBJECTIVE: To determine whether 595nm PDL treatment is effective for scars and keloids, and if so, which group responds better to treatment between the atrophic/flat scars group and hypertropic scars/keloids group. METHOD: Twenty-two patients (skin types III-V) with scars and keloids were treated with 595nm PDL (0.45 or 1.5 msec, 4-8J/cm(2), 7mm spot size). Eleven patients had hypertrophic scars/keloids (6 had hypertropic scars, 5 had keloids), and eleven patients had atrophic/flat scars. After several treatments of each lesion, the results were evaluated by extent of the patient's satisfaction and comparision of pre-and post-laser photography and divided into the four categories: excellent, good, fair and poor. RESULTS: The clinical improvement and patient's satisfaction were better in the atrophic/flat scars group than the hypertrophic scars/keloid group. With keloid potients, the result of treatment were found to be particularly poor. CONCLUSION: From our results, only atrophic/flat scars respond well to 595nm PDL treatment, and hypertrophic scars and keloids should be excluded from this treatments method.
Cicatrix* ; Cicatrix, Hypertrophic ; Humans ; Keloid* ; Lasers, Dye* ; Photography