Background: This study investigated the relationships of thigh and waist circumference with the hemoglobin glycation index (HGI) and carotid atherosclerosis in patients with type 2 diabetes. Methods: This observational study included 3,075 Korean patients with type 2 diabetes, in whom anthropometric measurements and carotid ultrasonography were conducted. HGI was defined as the measured hemoglobin A1c (HbA1c) level minus the predicted HbA1c level, which was calculated using the linear relationship between HbA1c and fasting plasma glucose levels. Carotid atherosclerosis was defined as a clearly isolated focal plaque or focal wall thickening >50% of the surrounding intima-media thickness. Results: The frequency of a positive HGI decreased with increasing thigh circumference in men and increased with increasing waist circumference in women after adjusting for potential confounding variables. Thigh and waist circumference had a combined augmentative effect on the likelihood of positive HGI, which was dramatically higher in patients in higher waist-to-thigh ratio quartiles (adjusted odds ratios for the highest compared to the lowest quartile: 1.595 in men and 1.570 in women). Additionally, the larger the thigh circumference, the lower the risk of carotid atherosclerosis, although in women, this relationship lacked significance after adjustment for potential confounders. Conclusion HGI was associated with thigh circumference in men and waist circumference in women. In addition, the combination of low thigh circumference and high waist circumference was strongly associated with a higher HGI in Korean patients with type 2 diabetes. In particular, thigh circumference was associated with carotid atherosclerosis in men. However, further longitudinal studies are warranted.

No abstract available.
Korea* ; Uropathogenic Escherichia coli*

Globicatella sanguinis is an unusual pathogen causing bacteremia, meningitis, and urinary tract infection, and can be misidentified as Streptococcus pneumoniae or viridans streptococci due to its colonial morphology. A 76-year-old female patient with hypertension and degenerative arthritis was admitted to the hospital complaining of knee joint pain. Blood culture revealed the presence of Gram-positive cocci, and the isolated organism was equally identified as S. pneumoniae using the MicroScan identification system (Beckman Coulter, USA) and Vitek 2 identification system (bioMérieux, USA). However, the isolate showed optochin resistance based on the optochin disk susceptibility test. The organism was finally confirmed to be G. sanguinis based on 16S rRNA sequencing and hydrogen sulfide production testing. Accurate identification of G. sanguinis isolated from aseptic body fluids including blood is important for appropriate antibiotic selection based on accurate application of interpretative criteria of antimicrobial susceptibility test.
Aged ; Bacteremia* ; Body Fluids ; Female ; Gram-Positive Cocci ; Humans ; Hydrogen Sulfide ; Hypertension ; Knee Joint ; Meningitis ; Osteoarthritis ; Pneumonia ; Streptococcus pneumoniae ; Urinary Tract Infections ; Viridans Streptococci

No abstract available.
Bacteremia* ; Korea* ; Pasteurella multocida* ; Pasteurella*

No abstract available.
Aerococcus* ; Gene Expression* ; Korea* ; Vancomycin Resistance* ; Vancomycin*

BACKGROUND: Hemolytic specimens contain components that interfere with clinical laboratory results. We evaluated previously published hemolysis indices (HI) and developed an algorithm for differentiating between mechanical hemolysis and immune-mediated hemolysis based on complete blood count (CBC). METHODS: Sixty-three residual EDTA (ethylenediamine tetraacetic acid)-anticoagulated blood specimens were obtained during regular health check-ups, and each specimen was divided into 3 aliquots (A control, B, and C group). Aliquots B and C were mechanically hemolysed by 2 and 5 aspirations, respectively, using a 25-gauge needle before testing; aliquot A was analysed immediately without hemolysis. Additionally, we collected 36 specimens from patients suspected of having immune-mediated hemolysis after thorough reviewing their various laboratory results including direct antiglobulin test. We compared CBC parameters between the groups (A, B, C, D [B+C], and E [immune-mediated hemolysis group]). RESULTS: Our HI scoring system using the sum of red blood cell ghosts, measured hemoglobin-calculated hemoglobin, mean corpuscular hemoglobin concentration-corpuscular hemoglobin concentration mean, and mean platelet volume rather than mean corpuscular hemoglobin, effectively identified mechanical hemolysis; the results were similar to those of previous studies. Furthermore, the HI score using the sum of mean corpuscular volume, red cell distribution width, hemoglobin distribution width, polymorphonuclear %, and neutrophil % differentiated mechanical hemolysis from immune-mediated hemolysis (cut-off, 9; sensitivity, 91.7%; specificity, 92.9%; area under the receiver operating characteristic curve, 0.965 [95% confidence interval, 0.924–0.988]). CONCLUSIONS: The newly developed algorithm may provide effective screening for detecting hemolysis and differential diagnosis of mechanical hemolysis and immune-mediated hemolysis based on CBC results.
Aspirations (Psychology) ; Blood Cell Count ; Coombs Test ; Diagnosis, Differential* ; Edetic Acid ; Erythrocyte Indices ; Erythrocytes ; Hemolysis* ; Humans ; In Vitro Techniques* ; Mass Screening ; Mean Platelet Volume ; Needles ; Neutrophils ; ROC Curve ; Sensitivity and Specificity

BACKGROUND: Liver biopsy is the gold standard for assessing liver fibrosis; however, it has a relatively high risk of resulting in complications. Although a non-invasive method (i.e., transient elastography—fibroscan) was introduced, it is expensive and is dependent on the patient's status. Thus, the FIB-4 score, a non-invasive formula, has been used to predict the degree of liver fibrosis. The aim of this study was to evaluate the usefulness of the FIB-4 score in predicting stages of liver fibrosis. METHODS: We analysed the age, diagnosis, and liver stiffness of 282 patients by measuring the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) as well as their platelet count. Liver elasticity was evaluated by two classification criteria (Foucher et al. and Mueller et al.). The FIB-4 score was calculated using the formula: age×AST/(platelet count×ALT½). The cut-off value of the FIB-4 score was determined according to the area under the relative operating characteristic curve (AUC) based on liver elasticity. RESULTS: The FIB-4 cut-off values, as determined using two different criteria, have the highest AUC, thereby indicating a robust ability to distinguish between healthy liver tissue and the presence of any liver fibrosis. The FIB-4 score with a cut-off value of 2.07, as determined by Mueller et al., had the highest AUC (0.837) and odds ratio (2.741) with a sensitivity of 78.3% and a specificity of 76.5%. CONCLUSIONS: An FIB-4 score of 2.07 is a cut-off value that is useful in detecting fibrotic progression in chronic liver disease in our laboratory. Each laboratory should determine an appropriate FIB-4 cut-off value that is relative to the particular characteristics of their patient population.
Alanine Transaminase ; Area Under Curve ; Aspartate Aminotransferases ; Biopsy ; Classification ; Diagnosis ; Elasticity ; Humans ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Mass Screening* ; Methods ; Odds Ratio ; Platelet Count ; Sensitivity and Specificity

Streptococcus bovis bacteremia in humans has been traditionally associated with infective endocarditis, colorectal cancer, and liver cirrhosis. S. bovis strains were previously categorized by biotype, but since the 2000s, they have been reclassified by DNA homology. We report a case of S. gallolyticus subsp. gallolyticus bacteremia, identified by 16S rRNA sequencing, in a patient diagnosed with liver cirrhosis. A 61-yr-old man with a history of liver cirrhosis presented to the hospital with a complaint of fever. Blood culture revealed the presence of gram-positive cocci, and the isolated organism was identified as S. bovis by the MicroScan identification kit (Beckman Coulter, USA), but as Enterococcus saccharolyticus by the Vitek 2 identification kit (bioMérieux, USA). The organism was finally confirmed as S. gallolyticus subsp. gallolyticus by 16S rRNA sequencing.
Bacteremia* ; Colorectal Neoplasms ; DNA ; Endocarditis ; Enterococcus ; Fever ; Gram-Positive Cocci ; Humans ; Liver Cirrhosis* ; Liver* ; Streptococcus bovis ; Streptococcus*

A total of 1,132 pleural fluid culture results obtained from October 2012 to July 2014 were analyzed to elucidate the microbiological characteristics according to transudative and exudative pleural fluid. The pleural fluid cultures were performed using aerobic and anaerobic blood culture bottles. The blood and pleural fluid for total protein, lactate dehydrogenase, and glucose measurement were submitted to laboratory at the same time with pleural fluid cultures. The rates for culture positivity, anaerobes isolation, and polymicrobials between transudative and exudative pleural fluid were 5.2% vs. 10.4%, 14.8% vs. 7.8%, and 14.8% vs. 10.9%.
Exudates and Transudates ; Glucose ; L-Lactate Dehydrogenase

BACKGROUND: The identification of in vitro hemolysis (IVH) using a hematology analyzer is challenging because centrifugation of the specimens cannot be performed for cell counts. In the present study, we aimed to develop a scoring system to help identify the presence of hemolysis in anticoagulated blood specimens. METHODS: Thirty-seven potassium EDTA anticoagulated blood specimens were obtained, and each specimen was divided into 3 aliquots (A, B, and C). Aliquots B and C were mechanically hemolyzed by aspirating 2 and 5 times, respectively, using a 27-gauge needle and then tested; aliquot A was analyzed immediately without any hemolysis. After the cells were counted, aliquots B and C were centrifuged and the supernatants were tested for the hemolytic index and lactate dehydrogenase levels. RESULTS: The 4 hematologic parameters were selected and scored from 0 to 3 as follows:< 34.0, 34.0-36.2, 36.3-38.4, and > or =38.5 for mean cell hemoglobin concentration (MCHC, g/dL); <0.02, 0.02, 0.03, and > or =0.04 for red blood cell ghosts (10(12)/L); <0.13, 0.13-0.38, 0.39-1.30, and > or =1.31 for difference value (g/dL) of measured hemoglobin and calculated hemoglobin; and <0.26, 0.26-0.95, 0.96-3.34, and > or =3.35 for difference value (g/dL) of MCHC and cell hemoglobin concentration mean. The hemolysis score was calculated by adding all the scores from the 4 parameters. At the cutoff hemolysis score of 3, the IVH of aliquots B and C were detected as 64.9% and 91.9%, respectively. CONCLUSIONS: The scoring system might provide effective screening for detecting spurious IVH.
Anticoagulants/*pharmacology ; *Blood Specimen Collection ; Edetic Acid/pharmacology ; Hemoglobins/analysis ; Hemolysis/drug effects ; Humans