PURPOSE: This study determined the prenatal and postnatal factors associated with complications and prognosis in premature infants with leukemoid reaction. METHODS: We retrospectively reviewed the medical records of premature infants with gestational ages <37 weeks and low birth weights (<2,500 g) who were admitted immediately after birth to the neonatal intensive care unit at the Dongguk University Ilsan Hospital between June 2005 and July 2006. A leukemoid reaction was defined as an absolute neutrophil count (ANC) >30,000/mm3. The infants who had leukemoid reaction comprised the study group, while the remainder of infants made up the control group. The relationships between maternal and neonatal variables and ANC were studied. RESULTS: Leukemoid reaction was detected in 3.1% of the study infants (8 of 252). Factors more frequently associated with infants with leukemoid reaction were as follows: maternal chorioamnionitis, high levels of maternal and infant C-reactive protein, gestational age <37 weeks, birth weight <2,500 g, low Apgar score, prolonged ventilator support, and a high incidence of bronchopulmonary dysplasia (BPD). However, there were no significant differences with respect to the antenatal usage of steroids, the incidences of patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, and mortality between the two groups. CONCLUSION: Leukemoid reaction in premature infants was associated with chorioamnionitis and high levels of serum C-reactive protein in mothers and infants, and BPD in infants. These findings suggest that leukemoid reaction is secondary to inflammation caused by infection.
Apgar Score ; Birth Weight ; Bronchopulmonary Dysplasia ; C-Reactive Protein ; Chorioamnionitis ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Female ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Inflammation ; Intensive Care, Neonatal ; Leukemoid Reaction ; Medical Records ; Mothers ; Neutrophils ; Parturition ; Pregnancy ; Prognosis ; Retinopathy of Prematurity ; Retrospective Studies ; Steroids ; Ventilators, Mechanical

STUDY DESIGN: Retrospective case series. PURPOSE: The purpose of this study was to examine the incidence of neural axis abnormalities and the relevant risk factors in patients with adolescent idiopathic scoliosis (AIS). OVERVIEW OF LITERATURE: The use of preoperative magnetic resonance imaging (MRI) to assess the whole spine in patients with idiopathic scoliosis is controversial, and indications for such MRI evaluations have not been definitively established. However, we routinely use whole-spine MRI in patients with scoliosis who are scheduled to undergo surgical correction. METHODS: A total of 378 consecutive patients with presumed AIS who were admitted for spinal surgery were examined for neural axis abnormalities using MRI. To differentiate patients with normal and abnormal MRI findings, the following clinical parameters were evaluated: age, sex, menarcheal status, rotation angle (using a scoliometer), coronal balance, shoulder height difference, and low back pain. We radiographically evaluated curve type, thoracic or thoracolumbar curve direction, curve magnitude and flexibility, apical vertebral rotation, curve length, coronal balance, sagittal balance, shoulder height difference, thoracic kyphosis, and the Risser sign. RESULTS: Neural axis abnormalities were detected in 24 patients (6.3%). Abnormal MRI findings were significantly more common in males than in females and were associated with increased thoracic kyphosis. However, there were no significant differences in terms of the other measured parameters. CONCLUSIONS: Among the patients with presumed AIS who received preoperative whole-spine MRI, 6.3% had neural axis abnormalities. Males and patients with increased thoracic kyphosis were at a higher risk.
Adolescent* ; Female ; Humans ; Incidence ; Kyphosis ; Low Back Pain ; Magnetic Resonance Imaging* ; Male ; Pliability ; Retrospective Studies ; Risk Factors ; Scoliosis* ; Shoulder ; Spine

Patients undergoing maintenance dialysis show an increased susceptibility to tuberculosis because host immunity is decreased secondary to malnutrition, impaired cellular immunity, acidosis and etc. Extrapulmonary tuberculosis is more prevalent in patients with end stage renal disease than in normal subjects. Among the extrapulmonary tuberculosis in patients receiving hemodialysis, the diagnosis of tuberculous spondylitis is difficult because the symptoms are non specific and attributable to uremia, and the appearance of plain radiographs is often normal during the early phase of the disease. We experienced a case of tuberculous spondylitis in a hemodialysis patient. A 55 years old female admitted with fever, weight loss and back pain. Conventional radiograph of T-spine showed no definite abnormal finding. However, chest CT revealed heterogeneously enhancing soft tissue around the T8 vertebral body and T-spine MRI showed compatible finding to tuberculous spondylitis. She received radical excision of involved vertebra and confirmed tuberculous spondylitis with histologic finding from a surgical specimen. Following the administration of anti-tuberculosis medication(isoniazid, rifampin, pyraziamide, ethambutol) and radical excision, patient's symptom and sign were improved. The patient is maintaining dialysis with anti-tuberculosis medication for 5 months.
Acidosis ; Back Pain ; Diagnosis ; Dialysis ; Female ; Fever ; Humans ; Immunity, Cellular ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Malnutrition ; Middle Aged ; Renal Dialysis* ; Rifampin ; Spine ; Spondylitis* ; Tomography, X-Ray Computed ; Tuberculosis ; Uremia ; Weight Loss

BACKGROUND: This study is aimed to investigate the effect of tramadol on the bispectral index (BIS) during anesthesia with desflurane. METHODS: One hundred fifty adults, ASA class 1 and 2 patients, scheduled for general anesthesia for elective surgical procedures were included in this study. None of the patients were premedicated and anesthesia was induced with propofol 2 mg/kg and maintained with air-oxygen (FiO2 0.5) and desflurane, adjusted to keep the BIS between from 50 and 60. Forty minutes before completing surgery, the subjects were randomly allocated into 3 groups to receive saline (control group), tramadol 1.5 mg/kg (T1 group) or 3.0 mg/kg (T2 group) intravenously. Hemodynamics and BIS values were then recorded every 5 minutes until completion of the operation, during which time the concentrations of desflurane were not modified. RESULTS: The mean BIS values after tramadol administration weren't significantly different from the control group throughout the period of observation. No significant changes in the hemodynamics were noted, except systolic and diastolic arterial blood pressure in the T1 and T2 groups significantly increased in the first 5 minutes after the tramadol injection. CONCLUSIONS: The results indicate that the administration of tramadol while maintaining anesthesia with desflurane, adjusted to keep the BIS between 50 and 60, does not modified BIS values. So, we propose that tramadol can be safely administered as an immediate postoperative analgesia without concern about intra-operative awareness.
Adult ; Analgesia ; Anesthesia ; Anesthesia, General ; Arterial Pressure ; Hemodynamics ; Humans ; Isoflurane ; Propofol ; Surgical Procedures, Elective ; Tramadol

To gain insight on the role of pro-inflammatory cytokines in the pathogenesis and treatment of rheumatoid arthritis (RA), the phorbol 12-myristate 13-acetate (PMA) -induced IL-6 gene expression and the effect of caffeic acid phenethyl ester (CAPE) on the PMA-induced IL-6 gene expression were investigated in human fibroblast-like synoviocytes (FLSs). Synovial tissue samples were obtained from rheumatoid arthritis patients, and FLSs were isolated. The cells were stimulated with PMA (100 nM) for 6 hrs to induce IL-6 gene. The cells were pretreated with CAPE (20, 50, 100 microM) prior to PMA treatment. PMA increased IL-6 RNA expression, binding activities of transcription factors (NF-kappaB, AP-1) to IL-6 promoter, and IL-6 promoter activity. However, CAPE inhibited PMA-induced IL-6 mRNA expression in dose-dependent manner, and also inhibited the increased binding activities of transcription factors to IL-6 promoter and IL-6 promoter activity. These results suggest that CAPE might regulate PKC-mediated IL-6 expression and inflammatory reactions in RA.
Arthritis, Rheumatoid* ; Cytokines ; Gene Expression* ; Humans ; Interleukin-6* ; RNA ; RNA, Messenger ; Transcription Factors

Purpose: Exon 20 insertion mutations (E20ins) in epidermal growth factor receptor (EGFR) or human epidermal growth factor receptor 2 (HER2) in non–small cell lung cancer (NSCLC) patients has become more important with emergence of novel agents targeting E20ins. Materials and Methods: Advanced/Metastatic NSCLC patients with E20ins were included. EGFR E20ins was identified by two methods, next-generation sequencing (NGS) or real-time polymerase chain reaction (PCR), while HER2 E20ins was done by NGS only. Results: Between December 2013 and July 2021, E20ins were identified in 107 patients at Asan Medical Center; 67 EGFR E20ins and 40 HER2 E20ins. Out of 32 patients with EGFR E20ins who had tested both PCR and NGS, 17 were identified only through NGS and the other 15 through both tests, giving a discordance rate of 53.1%. There was no clinically significant difference in clinicopathologic features between EGFR and HER2 E20ins; both were observed more frequently in adenocarcinoma, female and never-smokers. Brain metastases were evident at diagnosis in 31.8% of EGFR E20ins and 27.5% of HER2 E20ins, respectively. Platinum-based doublets demonstrated objective response rates (ORR) of 13.3% with a median progression-free survival (PFS) of 4.2 months for EGFR E20ins and 35.3% with 4.7 months for HER2 E20ins, respectively. In contrast, novel EGFR E20ins-targeted agents exhibited an ORR of 46.2% with a median PFS of 5.4 months, while HER2-targeted agents showed an ORR of 50% with that of 7.0 months. Conclusion Identification of EGFR and HER2 E20ins is more important as their targeted therapies improved outcomes. Upfront NGS test as a comprehensive molecular approach is strongly warranted.

In macrophages, lipopolysaccharide (LPS) alone or in combination with interferon- gamma (IFN- gamma) has been shown to release a nitric oxide (NO) through the increase of the transcription of the inducible nitric oxide synthase (iNOS) gene. To investigate the exact intracellular signaling pathway of the regulation of iNOS gene transcription by LPS plus IFN- gamma, the effects of protein tyrosine kinase (PTK) inhibitor and protein kinase C (PKC) inhibitors on NO production, iNOS mRNA expression, nuclear factor- kappaB (NF- kappaB) binding activity and the promoter activity of iNOS gene containing two NF- kappaB sites have been examined in a mouse macrophage RAW 264.7 cells. LPS or IFN- gamma, stimulated NO production, and their effect was enhanced synergistically by mixture of LPS and IFN- gamma. The PTK inhibitor such as tyrphostin reduced LPS plus IFN- gamma-induced NO production, iNOS mRNA expression and NF- kappaB binding activity. In contrast, PKC inhibitors such as H-7, Ro-318220 and staurosporine did not show any effect on them. In addition, transfection of RAW 264.7 cells with iNOS promoter linked to a CAT reporter gene revealed that tyrphostin inhibited the iNOS promoter activity through the NF- kappaB binding site, whereas PKC inhibitors did not. Taken together, these suggest that PTK, but not PKC pathway, is involved in the regulation of the iNOS gene transcription through the NF- kappaB sites of iNOS promoter in RAW 264.7 macrophages by LPS plus IFN- gamma.
1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine ; Animals ; Binding Sites* ; Cats ; Genes, Reporter ; Macrophages ; Mice ; Nitric Oxide ; Nitric Oxide Synthase Type II* ; Protein Kinase C ; Protein-Tyrosine Kinases* ; RNA, Messenger ; Staurosporine ; Transfection ; Tyrosine*

Diclofenac, a phenylacetic acid derivative, is a widely used non-steroidal anti-inflammatory drug (NSAID) to provide effective relief of inflammation and pain. Nitric oxide (NO) synthesized by inducible nitric oxide synthase (iNOS) has been implicated as a mediator of inflammation. We examined the inhibitory effects of diclofenac on the induction of iNOS in RAW 264.7 macrophages which were activated with lipopolysaccharide (LPS) plus interferon-gamma (IFN-gamma). Treatment of RAW 264.7 cells with diclofenac and other NSAIDs (aspirin and indomethacin) significantly inhibited NO production and iNOS protein expression induced by LPS plus IFN-gamma. Also, diclofenac but not aspirin and indomethacin, inhibited iNOS mRNA expression and nuclear factor-kappa B (NF-kappaB) binding activity concentration-dependently. Furthermore, transfection of RAW 264.7 cells with iNOS promoter linked to a CAT reporter gene revealed that only diclofenac inhibited the iNOS promoter activity induced by LPS plus IFN-gamma through the NF-kappaB sites of iNOS promoter. Taken together, these suggest that diclofenac may exert its anti-inflammatory effect by inhibiting iNOS gene expression at the transcriptional level through suppression of NF-kappaB activation.
Animals ; Anti-Inflammatory Agents, Non-Steroidal ; Aspirin ; Cats ; Diclofenac* ; Gene Expression* ; Genes, Reporter ; Indomethacin ; Inflammation ; Interferon-gamma ; Macrophages* ; NF-kappa B* ; Nitric Oxide ; Nitric Oxide Synthase Type II ; RNA, Messenger ; Transfection

Purpose: The benefit of adjuvant chemotherapy following curative-intent surgery in pancreatic ductal adenocarcinoma (PDAC) patients who had received neoadjuvant FOLFIRINOX is unclear. This study aimed to assess the survival benefit of adjuvant chemotherapy in this patient population. Materials and Methods: This retrospective study included 218 patients with localized non-metastatic PDAC who received neoadjuvant FOLFIRINOX and underwent curative-intent surgery (R0 or R1) between January 2017 and December 2020. The association of adjuvant chemotherapy with disease-free survival (DFS) and overall survival (OS) was evaluated in overall patients and in the propensity score matched (PSM) cohort. Subgroup analysis was conducted according to the pathology-proven lymph node status. Results: Adjuvant chemotherapy was administered to 149 patients (68.3%). In the overall cohort, the adjuvant chemotherapy group had significantly improved DFS and OS compared to the observation group (DFS: median, 13.8 months [95% confidence interval (CI), 11.0 to 19.1] vs. 8.2 months [95% CI, 6.5 to 12.0]; p < 0.001; and OS: median, 38.0 months [95% CI, 32.2 to not assessable] vs. 25.7 months [95% CI, 18.3 to not assessable]; p=0.005). In the PSM cohort of 57 matched pairs of patients, DFS and OS were better in the adjuvant chemotherapy group than in the observation group (p < 0.001 and p=0.038, respectively). In the multivariate analysis, adjuvant chemotherapy was a significant favorable prognostic factor (vs. observation; DFS: hazard ratio [HR], 0.51 [95% CI, 0.36 to 0.71; p < 0.001]; OS: HR, 0.45 [95% CI, 0.29 to 0.71; p < 0.001]). Conclusion Among PDAC patients who underwent surgery following neoadjuvant FOLFIRINOX, adjuvant chemotherapy may be associated with improved survival. Randomized studies should be conducted to validate this finding.

BACKGROUND/AIMS: Primary epiploic appendagitis (PEA) is a rare cause of focal abdominal pain in otherwise healthy patients. Patients with acute abdominal pain are often misdiagnosed clinically as acute appendicitis or diverticulitis. The purpose of this study was to describe the clinical presentation and characteristic computed tomography (CT) findings of PEA. METHODS: We reviewed the clinical records and CT images of 23 consecutive patients in Korea who presented with acute abdominal pain between January 2005 and February 2009 and had radiologic signs of PEA. RESULTS: Twenty-three patients (7 females and 16 males; average age, 42+/-14 years) were diagnosed with symptomatic PEA. Abdominal pain localized to the left (8 patients [44.5%]) and right (10 patients [55.5%]) lower quadrants as the leading symptom. CT findings specific for PEA were present in all patients except one. The symptoms resolved within 1 week (mean, 3.5 days) with or without antibiotic treatment. CONCLUSIONS: In patients with localized, sharp, acute abdominal pain not associated with other symptoms, such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of PEA should be considered and the diagnosis confirmed by CT scan.
Abdomen, Acute ; Abdominal Pain ; Appendicitis ; Diverticulitis ; Female ; Fever ; Humans ; Korea ; Nausea ; Peas ; Vomiting