Background: The PLASMIC score is a convenient tool for predicting ADAMTS13 activity of ＜10%.Lactate dehydrogenase (LDH) is widely used as a marker of haemolysis in thrombotic thrombocytopenic purpura (TTP) monitoring, and could be used as a replacement marker for lysis. We aimed to validate the PLASMIC score in a multi-centre Asia Pacific region, and to explore whether LDH could be used as a replacement marker for lysis. Methods: Records of patients with thrombotic microangiopathy (TMA) were reviewed. Patients’ ADAMTS13 activity levels were obtained, along with clinical/laboratory findings relevant to the PLASMIC score. Both PLASMIC scores and PLASMIC-LDH scores, in which LDH replaced traditional lysis markers, were calculated. We generated a receiver operator characteristics (ROC) curve and compared the area under the curve values (AUC) to determine the predictive ability of each score. Results: 46 patients fulfilled the inclusion criteria, of which 34 had ADAMTS13 activity levels of ＜10%. When the patients were divided into intermediate-to-high risk (scores 5‒7) and low risk (scores 0‒4), the PLASMIC score showed a sensitivity of 97.1% and specificity of 58.3%, with a positive predictive value (PPV) of 86.8% and negative predictive value (NPV) of 87.5%. The PLASMIC-LDH score had a sensitivity of 97.1% and specificity of 33.3%, with a PPV of 80.5% and NPV of 80.0%. Conclusion Our study validated the utility of the PLASMIC score, and demonstrated PLASMIC-LDH as a reasonable alternative in the absence of traditional lysis markers, to help identify high-risk patients for treatment via plasma exchange.

Purpose: Factors associated with invasive recurrence (REC) of ductal carcinoma in situ (DCIS) are less known. This study was aimed at identifying better biomarkers to predict the prognosis of DCIS. Methods: RNA extracted from formalin-fixed paraffin-embedded blocks of twenty-four pure DCIS cases was subjected to differential gene expression analysis. The DCIS cases were selected by matching age and estrogen receptor status. Sixteen REC-free and 8 invasive-REC cases with disease-free interval of > 5 years were analyzed. Immunohistochemistry (IHC) staining was used to validate sixty-one independent pure DCIS cases, including invasive-REC (n = 16) and REC-free (n = 45) cases. Results: Eight differentially expressed genes (DEGs) were statistically significant (log 2-fold change [FC] < –1 or > 1 and p < 0.001). Less than ½ fold expression of CUL1, androgen receptor (AR), RPS27A, CTNNB1, MAP3K1, PRKACA, GNG12, MGMT genes was observed in the REC group compared to the no evidence of disease group. AR and histone deacetylase 1 (HDAC1) genes were selected for external validation (AR: log 2-FC − 1.35, p < 0.001, and HDAC1: log 2-FC − 0.774, p < 0.001). External validation showed that the absence of AR and high HDAC1 expression were independent risk factors for invasive REC (hazard ratio [HR], 5.04; 95% confidence interval [CI], 1.24–20.4; p = 0.023 and HR, 3.07; 95% CI, 1.04–9.04; p = 0.042). High nuclear grade 3 was also associated with long-term invasive REC. Conclusion Comparative gene expression analysis of pure DCIS revealed 8 DEGs among recurring cases. External validation with IHC suggested that the absence of AR and overexpression of HDAC1 are associated with a greater risk of long-term invasive REC of pure DCIS.

PURPOSE: Ductal carcinoma in situ (DCIS) is a high-risk disease for the development of invasive tumors. Although it is associated with excellent prognosis, many patients undergo extensive treatment with surgery, radiation, and endocrine therapy. This study evaluated the clinical and pathologic factors associated with invasive recurrence, particularly locoregional, distant disease after breast-conserving surgery (BCS). METHODS: This study included 431 patients diagnosed with pure DCIS after BCS between January 2000 and December 2008. The clinicopathological characteristics, margin status, adjuvant therapy, and duration of endocrine therapy were evaluated in hormone receptor-positive DCIS patients. RESULTS: The median duration of follow-up was 115 months. During this period, 37 cases (8.5%) of recurrence were observed (12 in situ and 23 invasive recurrence and 2 unknown cases). There was no distant metastasis as first event. Similarly, none of the initial in situ recurrence cases developed distant metastasis while eight (32%, 8/23) developed distant metastasis after invasive recurrence. Overall recurrence was associated with young age (≤40 years) (HR: 3.60, 95% confidence interval [CI]: 1.77–7.32) and hormone receptor negativity (HR: 3.33, 95% CI: 1.52–7.29). Invasive local recurrence was independently associated with young age (≤40 years) (HR: 3.86, 95% CI: 1.50–9.96), high nuclear grade (HR: 4.46, 95% CI: 1.62–12.27) and omission of adjuvant radiotherapy (HR: 6.45, 95% CI: 1.82–22.82). Notably, duration of endocrine treatment among the hormone receptor positive patient group, was numerically shorter for recurred patients, though not statistically significant. CONCLUSION Young age, high nuclear grade and absence of adjuvant radiotherapy were independently associated with an increased risk of invasive recurrence. Moreover, invasive locoregional recurrence as a first event was associated with worse outcomes, yet in situ recurrence didn't affect overall survival. Further studies with larger sample sizes are warranted to confirm the prognostic indicators of recurrence and the optimal strategy for adjuvant therapy in this setting.

OBJECTIVE: To investigate the predictive index of functional recovery after primary pontine hemorrhage (PPH) using the combined motor evoked potential (MEP) and somatosensory evoked potential (SEP) in comparison to the hematoma volume and transverse diameter measured with computerized tomography. METHODS: Patients (n=14) with PPH were divided into good- and poor-outcome groups according to the modified Rankin Score (mRS). We evaluated clinical manifestations, radiological characteristics, and the combined MEP and SEP responses. The summed MEP and SEP (EP sum) was compared to the hematoma volume and transverse diameter predictive index of global disability, gait ability, and trunk stability in sitting posture. RESULTS: All measures of functional status and radiological parameters of the good-outcome group were significantly better than those of the poor-outcome group. The EP sum showed the highest value for the mRS and functional ambulatory category, and transverse diameter showed the highest value for "sitting-unsupported" of Berg Balance Scale. CONCLUSION: The combined MEP and SEP is a reliable and useful tool for functional recovery after PPH.
Evoked Potentials, Motor ; Evoked Potentials, Somatosensory* ; Gait ; Hematoma ; Hemorrhage* ; Humans ; Posture

OBJECTIVES: To investigate the effect of the occupational exposure to organic solvent on the olfactory function of shipyard painters; we measured the prevalence of olfactory function impairment between the exposure group and the controls by using the Korean Version of the Sniffin'Stick (KVSS) test through smell, and by analyzing factors related to olfactory alteration. METHODS: The olfactory function of 245 painters exposed to organic solvents was compared to that of 122 unexposed controls. A total of 367 shipyard subjects underwent questionnaire study and the olfactory function test was performed by KVSS test I from April to August 2007. Suspected subjects of abnormal findings were referred to an otorhinolaryngologist. In addition, the Biologic Exposure Index (BEI) and industrial hygiene laboratory data were collected as well as analyzed by job title in the exposure group. RESULTS: The difference in the result of KVSS test I was significantly different from the exposure group and the controls (P<0.05). For the exposure group, reduced olfaction and exposure group were correlated with statistical significance when compared to the controls (P<0.01). Adjusting for work duration, smoking, rhinitis or sinusitis history, exposure of the organic solvent (OR 1.76, 95% CI=1.05-2.96) had a statistically meaningful relationship with decreased olfaction. The data on BEI for the exposure group were collected; the difference in methylhippuric acid was significant between spray workers and others, but did not correlate well with decreased olfaction. CONCLUSION: Occupational exposure to organic solvents in shipyard painters may affect the olfactory function. Therefore, shipyard painters should be monitored on a periodic bases by the quantitative test such as KVSS test. There is no other quantitative testing method or standardized procedure that can objectively diagnose the neurotoxic effect, further enhanced quality research in this field is necessary.
Occupational Exposure ; Occupational Health ; Paintings ; Prevalence ; Questionnaires ; Rhinitis ; Sinusitis ; Smell ; Smoke ; Smoking ; Solvents

BACKGROUND: With increasing industrial development, opportunities are growing to contact electricity in the workplace or home. Therefore, the risk of electrical accident has been increased gradually. In general, electrical injuries involve the extremities and result in amputation or severe disability of limbs. Delayed spinal cord injury and peripheral neuropathies following electrical accidents are extremely rare. CASE REPORT: A 32-year-old man with 10 years working experience at a CRT-monitor manufacturer with repetitive exposures to high voltage current visited our hosipital. He complained of left leg weakness and atrophy, and intermittent pain. The symptoms were progressive. Other symptoms occurred such as nocturia, hesitancy, and weak urinary stream. We examined the patient and conducted EMG, L-spine MRI, neurometer test, isokinetic strength test, and physical examination. The results showed neural injuries due to anterior horn lesions or compression of the left femoral nerve pathway, with a consequent diagnosis of neurogenic bladder.
Adult ; Amputation ; Animals ; Atrophy ; Diagnosis ; Electricity ; Extremities ; Femoral Nerve ; Horns ; Humans ; Leg ; Magnetic Resonance Imaging ; Muscular Atrophy ; Nocturia ; Peripheral Nervous System Diseases* ; Physical Examination ; Rivers ; Spinal Cord Injuries ; Urinary Bladder, Neurogenic

OBJECTIVE: This study was aimed to compare lipid peroxide level, total peroxyl radical-trapping antioxidative parameter (TRAP) value, and antioxidant vitamin level in the maternal venous plasma between normal pregnancy and preeclampsia. METHODS: Samples of venous plasma were obtained from 38 normal and 24 preeclamptic women. Lipid peroxides levels were measured by thiobarbituric acid reaction. The TRAP values were measured by Wayner's method, although some reaction conditions were modified. Ascorbic acid, retinol, alpah-tocopherol, and gamma-tocopherol were measured by high performance liquid chromatography. RESULTS: There was no significant correlation between the lipid peroxides level in the maternal venous plasma and gestational age in normal pregnancy (n=38, r=0.04, p=NS). The lipid peroxide level in the maternal venous plasma of preeclampsia (n=24) was significantly higher than that of gestational age-matched normal pregnancy (n=26), (4.39 +/- 0.38 vs. 3.23 +/- 0.15 nmol/mg protein, p<0.01). There was no significant correlation between the TRAP value in the maternal venous plasma and gestational age in normal pregnancy (n=38, r=0.02, p=NS). The TRAP value in the maternal venous plasma of preeclampsia (n=24) was significantly lower than that of gestational age-matched normal pregnancy (n=26), (0.33 +/- 0.02 vs. 0.38 +/- 0.02 mM, p<0.05). Ascorbic acid level in the maternal venous plasma of preeclampsia was significantly lower than that of normal pregnancy (377.8 +/- 23.6 vs. 552.2 +/- 52.1 nmol/mL, p<0.05). However, there was no significant difference in maternal venous plasma retinol, alpah-tocopherol, and gamma-tocopherol levels between normal pregnancy and preeclampsia. CONCLUSION: The above results suggest that the imbalance of increased lipid peroxidation and decreased antioxidant activity were in the maternal blood of preeclampsia, and an antioxidant vitamin, ascorbic acid, may be decreased result from counteracting free radical-mediated cell disturbance.
Antioxidants ; Ascorbic Acid ; Chromatography, Liquid ; Female ; gamma-Tocopherol ; Gestational Age ; Humans ; Lipid Peroxidation ; Lipid Peroxides ; Oxidative Stress ; Plasma* ; Pre-Eclampsia* ; Pregnancy ; Vitamin A ; Vitamins*

BACKGROUND: Type 2 diabetes develops because of defects in both insulin secretion and action. The half-life of insulin in uremia is prolonged because the metabolic clearance rate of insulin in diabetic end stage renal disease (ESRD) patients is reduced with consequence that the dose of insulin and/or oral hypoglycemic agent (OHA) administered in normal renal function make them increase the risk of hypoglycemia. Therefore, we should usually reduce the dose of insulin and/or OHA, or stop administration of insulin and/or OHA if type 2 diabetic patients are progressed to ESRD. But in some patients, that is not true. The aim of this study was to test the hypothesis that insulin resistance plays an important role in (re)evaluation of optimal insulin and/or OHA dose for glycemic control after type 2 diabetic patients are progressed to ESRD. METHODS: Insulin resistance was examined in 23 type 2 diabetic ESRD patients with tight control of glycemia using the K index of the insulin tolerance test (Kitt). We divided 23 patients into three groups. Group 1 (n=10) was defined as patients who were administered neither insulin nor OHA after ESRD. Group 2 (n=9) was defined as patients who were changed from insulin to OHA as drug for glycemic control after ESRD. Group 3 (n=4) was defined as patients in whom insulin or OHA was continuously administered after ESRD without a change of them for glycemic control. We compared the degree of insulin resistance among these three groups. RESULTS: Insulin resistance determined by Kitt was significantly different between group 1 (Kitt, 2.1422/0.94-4.01%/min), group 2 (Kitt, 1.3811/0.79- 3.90%/min) and group 3 (Kitt, 0.8550/0.44-1.81%/min) by using Kruskal-Wallis test (p=0.048). Kitt in group 3 was significantly lower than in group 1 by using Mann-Whitney test (p=0.016). CONCLUSION: Although metabolic clearance of insulin is reduced by renal failure, demand of insulin/ OHA for optimal glycemic control is not reduced in higher insulin-resistant type 2 diabetic ESRD patients on hemodialysis. Insulin resistance plays an important role in determination of optimal insulin/ OHA dose for glycemic control after type 2 diabetic patients are progressed to ESRD.
Half-Life ; Humans ; Hypoglycemia ; Insulin Resistance* ; Insulin* ; Kidney Failure, Chronic* ; Metabolic Clearance Rate ; Renal Dialysis* ; Renal Insufficiency ; Uremia

Branchioma ; Carotid Body Tumor ; Diagnosis ; Diagnosis, Differential ; Head ; Hemangioma ; Hodgkin Disease ; Humans ; Lymph Nodes ; Lymphangioma, Cystic ; Lymphoma ; Lymphoma, Non-Hodgkin ; Neck ; Neoplasm Metastasis ; Oropharynx ; Parotid Gland ; Parotid Region ; Rare Diseases ; Retrospective Studies ; Tongue

Absorptiometry, Photon ; Adult ; Aged ; Bone Density ; Chungcheongbuk-do ; Female ; Humans ; Ilium ; Male ; Middle Aged ; Osteoporosis ; Tibia ; Tissue Donors ; Transplants ; Volunteers