BACKGROUND: In spite of a trend of automation for conducting most clinical laboratory tests, many blood banks are still dependent on manual tests. The aim of this study was to evaluate a full automation system called the Galileo (Immucor, USA) for conducting pretransfusion tests. METHODS: From August to October in 2009, a total of 3,002 cases of ABO-RhD typing and 1698 cases of antibody screening were compared between using manual tests and the Galileo system at Seoul National University Hospital, Seoul, Korea. For the manual tests, we used the slide method for ABO-RhD typing and the anti-human immunoglobulin treated microplate method for antibody screening. The Galileo system used the microplate method for ABO-RhD typing and the solid-phase red cell adherence (SPRCA) method for antibody screening. We calculated the overall concordance rate and the false positive or negative rates regarding the manual method as a standard test and the Galileo system as a comparative test. RESULTS: When comparing 3,002 cases of ABO-RhD typing, 52 cases (1.7%) were retested. A discrepancy between the two tests remained in 17 cases (0.6%) after repetition, which led to a concordance rate of 99.4% (2,985/3,002). On the comparison of 1,698 cases of antibody screening, 54 cases (3.2%) were retested. A discrepancy between the two tests remained for 30 cases (1.8%) and the concordance rate was 98.2% (1,615/1,698). Among the 20 false negative cases (1.2%), nine were thought to be cold antibodies with no cases of confirmed warm antibody. CONCLUSION: The automated Galileo system and the preexisting manual tests showed very good concordance for ABO-RhD typing and antibody screening. The Galileo system can be used with confidence for routine pretransfusion tests.
Antibodies ; Automation ; Blood Banks ; Cold Temperature ; Immunoglobulins ; Korea ; Mass Screening

Background and Objectives: Oropharyngeal cancers (OPCs) can be staged down to a lower stage with p16 positivity and de-escalated therapy has been the common practice. The aim of this study is to evaluate the survival outcomes based on various clinical factors in advanced OPC patients. Subjects and Method A total of 58 OPC patients in the stage IVA based on the American Joint Committee on Cancer 7th edition were treated with primary surgery or primary chemoradiation therapy from 2010 to 2016. A survival analysis was carried out using the Kaplan- Meier method, log-rank test, and Cox proportional hazards model. Results: The median follow-up was 39.5 months. Thirty-eight and 20 patients received surgery- based and radiation therapy (RT)-based treatments, respectively. Clinical T-stage and treatment method were significant risk factors for 5-year disease-free survival (DFS) rate, and the treatment method was the only significant risk factor for overall-survival (OS) rate. 5-year DFS rate in the surgery-based treatment and RT-based treatment was 76.1% and 36.0% (p=0.001). On multivariate analysis, the surgery-based treatment group was associated with a significantly reduced hazard of death [the hazard ratio (HR) for the radiation-based treatment was 6.565 compared to the surgery-based treatment, p=0.002]. 5-year OS rate in the surgery-based treatment and RT-based treatment was 91.1% and 53.4% (p=0.003), respectively. On the multivariate analysis, the surgery-based treatment group was associated with a significantly reduced hazard of death (the HR for the radiation-based treatment was 7.544 compared to the surgerybased treatment, p=0.012). Conclusion The primary surgery-based treatment for advanced OPC showed a better survival outcome than the primary radiation-based treatment, irrespective of p16 positivity.

OBJECTIVES: To investigate the therapeutic effect of cranial electrotherapy stimulation (CES) with sleep hygiene in patients with chronic insomnia. METHODS: This study was designed as a prospective, double-blinded, and randomized controlled trial. Twenty-seven patients with chronic insomnia were recruited and randomly allocated to two groups; cranial microcurrent therapy (MC) group and sham group. All patients received sleep hygiene education. Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were measured at baseline (pre-treatment), and 2 weeks and 4 weeks of treatment. RESULTS: In MC group, the PSQI and ISI showed a tendency to decrease consistently until 4 weeks of treatment. In sham group, PSQI and ISI initially decreased during the first 2 weeks, but it increased after 2 weeks of treatment. CONCLUSIONS: This study showed that combination treatment of CES and sleep hygiene is more effective in treating chronic insomnia than sleep hygiene only as demonstrated by improvement and maintenance of sleep score for 1 month.
Education ; Electric Stimulation Therapy ; Humans ; Hygiene ; Prospective Studies ; Sleep Initiation and Maintenance Disorders

PURPOSE: To investigate the correlation between pulmonary vascular dilatation on high-resolution computed tomography (HRCT) and expression of endothelial nitric oxide synthase (eNOS) after common bile duct ligation (CBDL) in the rabbit as a model of hepatopulmonary syndrome. MATERIALS AND METHODS: CBDL was done in 11 rabbits (2 weeks after CBDL, n = 5; 3 weeks after CBDL, n = 6). Four rabbits were done by abdominal incision with peritoneal suture only as a control group. HRCT scans were performed in the both groups. We evaluated peripheral pulmonary vascular dilatation in the upper and lower lobe. Tissue samples were immediately obtained from both upper and lower lobes of the lung and the liver after sacrifice. Dilatation of peripheral pulmonary vessel was correlated with the expression of endothelial nitric oxide synthase (eNOS) determined by Western blot. We also compared the degree of pulmonary vascular dilatation between the groups with administration of L-arginine (n = 5) and without administration of L-arginine (n = 6) after CBDL. RESULTS: Two weeks after CBDL, pulmonary vascular dilatation on HRCT was seen in three rabbits (60%) and the increase of eNOS expression was shown in two rabbits (40%) in the lower lobe. Three weeks after CBDL, pulmonary vascular dilatation on HRCT was seen in four rabbits (66.7%) and five rabbits (83.3%) each upper and lower lobe, respectively. Expression of eNOS was coincidently increased. The pulmonary vascular dilatation was noted more frequently in the lower lobe than in the upper lobe. Pulmonary vascular dilatation on HRCT was highly correlated with increase of expression of eNOS in the upper (r = 1.00, p = .0001) and lower lobe (r = .83, p = .0015). In contrast, control group of four rabbits developed neither pulmonary vascular dilatation on HRCT nor increase of eNOS expression. The grade of pulmonary vascular dilatation in the group with L-arginine administration was higher than that without administration of L-arginine (p < .05). CONCLUSION: Pulmonary vascular dilatation on HRCT is significantly correlated with increase of eNOS expression in a rabbit lung after CBDL. These results suggest that NO, derived from pulmonary eNOS, contributes to pulmonary vascular dilatation in a rabbit model of hepatopulmonary syndrome. Index words : Lung, CT Lung, effect of drugs on Lung, vascular disease
Arginine ; Blotting, Western ; Common Bile Duct ; Dilatation* ; Hepatopulmonary Syndrome* ; Ligation ; Liver ; Lung ; Nitric Oxide Synthase Type III ; Rabbits ; Sutures ; Vascular Diseases

OBJECTIVE: To investigate the correlation between radiologic vascular dilatation and serum nitrite concentration and eNOS expression in the endothelial cell and pneumocyte in a rabbit model of hepatopulmonary syndrome induced by common bile duct ligation (CBDL). MATERIALS AND METHODS: Thin-section CT scans of the lung and pulmonary angiography were obtained 3 weeks after CBDL (n=6), or a sham operation (n=4), and intrapulmonary vasodilatation was assessed. The diameter and tortuosity of peripheral vessels in the right lower lobe by thin-section CT and angiography at the same level of the right lower lobe in all subjects were correlated to serum nitrite concentration and eNOS (endothelial nitric oxide synthase) expression as determined by immunostaining. RESULTS: The diameters of pulmonary vessels on thin-section CT were well correlated with nitrite concentrations in serum (r = 0.92, p < 0.001). Dilated pulmonary vessels were significantly correlated with an increased eNOS expression (r = 0.94, p < 0.0001), and the severity of pulmonary vessel tortuosity was found to be well correlated with serum nitrite concentration (r = 0.90, p < 0.001). CONCLUSION: The peripheral pulmonary vasculature in hepatopulmonary syndrome induced by CBLD was dilated on thin-section CT and on angiographs. Our findings suggest that peripheral pulmonary vascular dilatations are correlated with serum nitrite concentrations and pulmonary eNOS expression.
Angiography ; Animals ; Common Bile Duct/injuries ; Dilatation, Pathologic/radiography ; Disease Models, Animal ; Endothelium, Vascular/metabolism ; Hepatopulmonary Syndrome/etiology/*metabolism ; Ligation ; Lung/*blood supply/metabolism/*radiography ; Nitric-Oxide Synthase/*metabolism ; Nitrites/*blood ; Pulmonary Artery/radiography ; Rabbits ; Research Support, Non-U.S. Gov't ; Tomography, X-Ray Computed/methods

We report a case of intraocular gnathostomiasis diagnosed by western blot assay in a patient with subretinal tracks. A 15-year-old male patient complained of blurred vision in the right eye, lasting for 2 weeks. Eight months earlier, he had traveled to Vietnam for 1 week and ate raw wild boar meat and lobster. His best-corrected visual acuity was 20/20 in both eyes and anterior chamber examination revealed no abnormalities. Fundus examination showed subretinal tracks in the right eye. Fluorescein angiography and indocyanine green angiography showed linear hyperfluorescence of the subretinal lesion observed on fundus in the right eye. Ultrasound examination revealed no abnormalities. Blood tests indicated mild eosinophilia (7.5%), and there was no abnormality found by systemic examinations. Two years later, the patient visited our department again for ophthalmologic evaluation. Visual acuity remained 20/20 in both eyes and the subretinal tracks in the right eye had not changed since the previous examination. Serologic examination was performed to provide a more accurate diagnosis, and the patient's serum reacted strongly to the Gnathostoma nipponicum antigen by western blot assay, which led to a diagnosis of intraocular gnathostomiasis. This is the first reported case of intraocular gnathostomiasis with subretinal tracks confirmed serologically using western blot in Korea.
Adolescent ; Animals ; Blotting, Western ; Fundus Oculi ; Gnathostoma/*isolation & purification ; Gnathostomiasis/*diagnosis/parasitology ; Humans ; Male ; Retinal Diseases/*diagnosis/parasitology ; Travel ; Vietnam

Bickerstaff's brainstem encephalitis (BBE), characterized by acute ophthalmoplegia and ataxia, often causes impaired consciousness and hyperreflexia. A 17-year-old man was admitted with an acute meningitic condition including high and neck stiffness. His condition rapidly deteriorated over 2 weeks, and he showed ophthalmoplegia, ataxia, seizure, tetraplegia, comatose mentality, and optic neuropathy. Electroencephalography showed diffuse slow waves. Visual evoked potentials showed no responses in the right eye. This is the first case of BBE with Guillain-Barre syndrome presenting with optic neuropathy and seizure.
Adolescent ; Ataxia ; Brain Stem* ; Coma ; Consciousness ; Electroencephalography ; Encephalitis* ; Evoked Potentials, Visual ; Guillain-Barre Syndrome* ; Humans ; Neck ; Ophthalmoplegia ; Optic Nerve Diseases* ; Quadriplegia ; Reflex, Abnormal ; Seizures*

BACKGROUND/AIMS: Previous studies have reported a high rate of sustained virologic response (SVR) and a low rate of serious adverse events with the use of daclatasvir (DCV) and asunaprevir (ASV) combination therapy. We evaluated the efficacy and safety of DCV and ASV combination therapy for patients with chronic hepatitis C virus (HCV) genotype 1b infection in real world. METHODS: We enrolled 278 patients (184 treatment-naïve patients) from five hospitals in Daegu and Gyeongsangbuk-do. We evaluated the rates of rapid virologic response (RVR), end-of-treatment response (ETR), and SVR at 12 weeks after completion of treatment (SVR12). Furthermore, we investigated the rate of adverse events and predictive factors of SVR12 failure. RESULTS: The mean age of patients was 59.5 ± 10.6 years, and 140 patients (50.2%) were men. Seventy-seven patients had cirrhosis. Baseline information regarding nonstructural protein 5A (NS5A) sequences was available in 268 patients. Six patients presented with pretreatment NS5A resistance-associated variants. The RVR and the ETR rates were 96.6% (258/267) and 95.2% (223/232), respectively. The overall SVR12 rate was 91.6% (197/215). Adverse events occurred in 17 patients (7.9%). Six patients discontinued treatment because of liver enzyme elevation (n = 4) and severe nausea (n = 2). Among these, four achieved SVR12. Other adverse events observed were fatigue, headache, diarrhea, dizziness, loss of appetite, skin rash, and dyspnea. Univariate analysis did not show significant predictive factors of SVR12 failure. CONCLUSIONS DCV and ASV combination therapy showed high rates of RVR, ETR, and SVR12 in chronic HCV genotype 1b-infected patients in real world and was well tolerated without serious adverse events.

PURPOSES: To investigate the viral etiology of community-acquired pneumonia in Korean adults, we have detected respiratory viruses (Respiatory syncytial virus, adenovirus, influenza virus and parainfluenza virus) in the way of prospective, multi-center study. METHODS: From July 1997 to April 2000, nasal aspirates or sputum were obtained from adults patients with community pneumonia admitted to the participating hospitals and transferred immediately to the central laboratory in the Seoul National University Children's Hospital. The specimens were divided into three parts. One part was used for indirect immunofluorescent test for respiratory viruses, the other part for the culture of RSV and adenovirus in HEp-2 cell monolayer. Another part was used for the culture of influenza virus and parainfluenza virus in MDCK or LLC- MK2 cell monolayers. RESULTS: Of 317 samples, 32 (10.1%) specimens were positive for viral isolation by indirect IF staining or culture, including one dual-infected specimen (adenovirus and parainfluenza virus). Influenza virus was most commonly detected (16 specimens). Parainfluenza virus, adenovirus and RSV were detected in 10, 4 and 3 patients, respectively. All isolated influenza viruses were type A (H3N2 in 9 patients, H1N1 in 2 and unspecified in 5), and 8 out of 10 parainfluenza virus isolates were type 3. CONCLUSION: Similar to previous foreign reports, a significant portion of community-acquired pneumonia in Korean adult is caused by respiratory viruses. Our data empathized the need of referral system for viral diagnosis and of nationwide investigation on respiratory virus infections.
Adenoviridae ; Adult* ; Diagnosis ; Humans ; Orthomyxoviridae ; Paramyxoviridae Infections ; Pneumonia* ; Prospective Studies ; Referral and Consultation ; Seoul ; Sputum

Background/Aims: Little is known about the national colonoscopy volume in Asian countries. This study aimed to assess the national colonoscopy volume in Korea over a 12-year period on the basis of a nationwide population-based database. Methods: We conducted a population-based study for colonoscopy claims (14,511,158 colonoscopies performed on 13,219,781 patients) on the basis of the Korean National Health Insurance Service database from 2002 to 2013. The 12-year national colonoscopy burden was analyzed according to patient age, patient sex, and healthcare facility type. Results: The overall volume of colonoscopy increased 8-fold over the 12-year period. The annual colonoscopic polypectomy rate significantly increased in all patient sex and age groups over the 12-years period (all p<0.001). The yearly colonoscopic polypectomy rate for men was significantly increased compared with that for women (2.3% vs 1.7%, p<0.001) and for the screening-age group compared with that for the young-age group (2.0% vs 1.6%, p<0.001). The yearly colonoscopic polypectomy rate relative to the total colonoscopy volume significantly increased in primary, secondary, and tertiary facilities by 2.4%, 1.9%, and 1.4% during the 12-year period (all p<0.001). In addition, the annual colonoscopy volume covered by high-volume facilities significantly increased by 1.8% in primary healthcare facilities over the 12-year period (p<0.001). Conclusions Healthcare resources should be prioritized to allow adequate colonoscopic capacity, especially for men, individuals in the screening-age group, and at primary healthcare facilities. Cost-effective strategies to improve the quality of colonoscopy may focus on primary healthcare facilities and high-volume facilities in Korea.