Multiple myeloma (MM), a hematological malignancy, is characterized by malignant plasma cell proliferation in the bone marrow. Recent treatment advances have significantly improved patient outcomes associated with MM.In this study, we aimed to develop comprehensive, evidence-based guidelines for the diagnosis, prognosis, and treat‑ ment of MM. We identified 12 key clinical questions essential for MM management, guiding the extensive literature review and meta-analysis of the study. Our guidelines provide evidence-based recommendations by integrating patient preferences with survey data. These recommendations include current and emerging diagnostic tools, thera‑ peutic agents, and treatment strategies. By prioritizing a patient-centered approach and rigorous data analysis, these guidelines were developed to enhance MM management, both in Korea and globally.

Purpose: The aim of this study is to demonstrate the association between recurrent atrial fibrillation (AF) and left ventricular (LV) adverse remodeling after catheter ablation and to evaluate the change of myocardial extracellular volume fraction (ECV) by catheter ablation outcomes. Materials and Methods: We retrospectively recruited 60 patients (44 men and 16 women) with a median age of 57 years (range, 32–78 years) who underwent cardiac MRI before and at 6–12 months after catheter ablation of AF. Cardiac MRI quantified myocardial ECV (%) in the left ventricle. Depending on myocardial ECV after catheter ablation, patients were divided into two groups: 1) LV adverse remodeling with ECV ≥ 28%; and 2) no adverse LV remodeling with ECV < 28%. Multivariable analysis was performed to assess the association between recurrent AF and LV remodeling. Results: Of 60 patients, 21 (35%) were in the LV adverse remodeling group (mean ECV ± standard deviation [SD]: 29.8% ± 1.4%) and 39 (65%) were in the no adverse LV remodeling group (mean ECV ± SD: 24.7% ± 1.5%). The incidence of recurrent AF was significantly greater in the LV adverse remodeling group than in the no adverse LV remodeling group (81% vs. 13%, p < 0.001). In patients with recurrent AF, mean myocardial ECV significantly increased from 27.7% ± 2.3% to 29.2% ± 2.3% (p = 0.004) after catheter ablation. In a multivariable analysis after adjusting sex, age, and myocardial ECV before catheter ablation, recurrent AF was independently associated with LV adverse remodeling after catheter ablation (odds ratio: 28.9, 95% confidence interval: 6.8–121.7, p < 0.001). Conclusion When monitoring with cardiac MRI, sustained AF was significantly associated with LV adverse remodeling through an increase in myocardial ECV after catheter ablation of AF.

Green tea, the leaves of Camellia sinsneis (Theaceae), is generally acknowledged as the most consumed beverage with multiple pharmacological functions including antioxidant activity. This study was performed to analyze the effect of extraction conditions of green tea on its antioxidant effects using DPPH assay. Three extraction factors such as extraction solvent (EtOH, 0 – 100%), extraction time (3 – 15 min) and extraction temperature (10 – 70℃) were analyzed and optimized extraction condition for antioxidant activity of green tea extract (GTE) was determined using response surface methodology with three-level-three-factor Box-Behnken design (BBD). Regression analysis showed a good fit of data and the optimal conditions of extraction were found to be 57.7% EtOH, 15 min and 70℃. Under this condition, antioxidant activity of experimental data was 88.4% which was almost fit to the ideal value of 88.6%. As epigallocatechin gallate (EGCG) is known for the major ingredient for antioxidant activity of green tea, we investigated the effect of EGCG on antioxidant activity of GTE. EGCG showed antioxidant activity with the IC50 value of 4.2 µg/ml and a positive correlation was observed between EGCG content and the antioxidant activity of GTE with R2 = 0.7134. Interestingly, however, GTE with 50 – 70% antioxidant activity contain less than 1.0 µg/ml of EGCG, which is much lower than IC50 value of EGCG. Therefore, we suppose that EGCG together with other constituents contribute to antioxidant activity of GTE. Taken together, these results suggest that green tea is more beneficial than EGCG alone for antioxidant ability and optimal extraction condition of green tea will be useful for the development of food and pharmaceutical applications.
Antioxidants ; Beverages ; Camellia ; Inhibitory Concentration 50 ; Tea*

Intraperitoneal (IP) vancomycin is widely used to treat Gram-positive peritonitis associated with peritoneal dialysis. There have been two cases of red man syndrome (RMS), a vancomycin-specific nonimmunologic reaction, associated with IP vancomycin. However, immune-mediated hypersensitivity reaction to IP vancomycin has not yet been reported. A 49 year old woman on continuous ambulatory peritoneal dialysis developed her first peritonitis episode. The patient was treated with IP vancomycin once/wk for 4 weeks. She experienced mild itching and flushing throughout her body for 1 day after the second treatment. Whenever vancomycin was administered, generalized urticaria and a prickling sensation developed, and the intensity increased gradually; however, these symptoms improved after vancomycin was discontinued. An allergic skin test was performed 6 weeks after the previous urticarial episode, and an intradermal skin test revealed a positive response to vancomycin. To our knowledge, this is the first case report of immunoglobulin E-mediated hypersensitivity reaction to IP vancomycin administration.
Female ; Flushing ; Humans ; Hypersensitivity* ; Immunoglobulins* ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Pruritus ; Sensation ; Skin Tests ; Urticaria ; Vancomycin*

PURPOSE: This study evaluated the usefulness of ultrasonography for a diagnosis of acetabular labral tear in femoroacetabular impingement (FAI). MATERIALS AND METHODS: From March 2010 to October 2011, an ultrasonographic examination was performed in 58 patients(58 hips: 26 men and 32 women) with acetabular labral tear. The sensitivity and positive predictive value of ultrasonography were evaluated for 58 cases with acetabular labral tear confirmed by hip arthroscopy. RESULTS: The sensitivity and positive predictive value for an acetabular labral tear using ultrasonography was 89.6% and 100%, respectively. The concordance rate of an acetabular labral tear between arthroscopy and ultrasonography was 84.6%. CONCLUSION: Hip ultrasonography can make a significant contribution to a pathologic diagnosis and isa useful diagnostic tool for acetabular labral tears.
Arthroscopy ; Femoracetabular Impingement ; Hip ; Humans ; Male

Toxoplasmosis is an infection caused by Toxoplasma gondii. It can be lethal in immunocompromised hosts, such as a transplant recipients or patients infected with human immunodeficiency virus. In solid organ transplant recipients, toxoplasmosis results mainly from transmission of the parasite with an allograft in cases of serological mismatch. Toxoplasmosis in an immunocompromised host is associated with high mortality. Thus, early diagnosis and treatment is very important. We report on a case of toxoplasmosis in a 51-year-old male patient who had undergone deceased donor kidney transplantation. He suffered from fever of unknown origin. He was finally diagnosed with toxoplasmosis, and treated successfully with trimethoprim-sulphamethoxazole.
Early Diagnosis ; Fever ; Fever of Unknown Origin ; HIV ; Humans ; Immunocompromised Host ; Kidney Transplantation* ; Kidney* ; Male ; Middle Aged ; Mortality ; Parasites ; Tissue Donors ; Toxoplasma ; Toxoplasmosis* ; Transplantation ; Transplantation, Homologous ; Transplants

A 67-year-old male renal transplant patient presented with a right inguinal bulging mass, and was diagnosed with a right indirect inguinal hernia. The day following inguinal herniorrhaphy, serum creatinine became elevated. The patient was oliguric and had abdominal pain on the first day after inguinal herniorrhaphy with a mesh. We diagnosed him with acute renal failure and subsequently performed acute hemodialysis. The kidney computed tomography showed hydronephroureter, with distal ureter obstruction. With urgent percutaneous nephrostomy, we were able to relieve the obstructive uropathy with distal ureteral stenosis. Subsequently, hernia repair was performed with removal of the mesh, followed by the antegrade ureteral stent insertion. Renal function was recovered after ureteral stent insertion. This case shows that acute renal failure can occur due to ureteral obstruction, complicated by an inguinal hernia repair, and this can be successfully treated with percutaneous nephrostomy and inguinal hernia repair with mesh removal.
Abdominal Pain ; Acute Kidney Injury ; Aged ; Constriction, Pathologic ; Creatinine ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Kidney ; Male ; Nephrostomy, Percutaneous ; Renal Dialysis ; Stents ; Transplants ; Ureter ; Ureteral Obstruction

Collapsing glomerulopathy (CG) has become an important cause of end-stage renal disease (ESRD). First delineated from other proteinuric glomerular lesions in the 1980s, CG is now recognized as a common, distinct pattern of proliferative parenchymal injury that portends a rapid loss of renal function and poor responses to empirical therapy. The first cases in the literature trace back to human-immunodeficiency-virus (HIV)-negative patients who underwent biopsy in 1979. A 45-year-old male patient complained of hematuria and proteinuria eight years ago. He showed an abrupt serum creatinine increase from 1.75 to 2.65mg/dL in the last preceding months. Afterwards, his serum creatinine progressively increased up to 6.82mg/dL. Moreover, his 24 h urine protein level was determined to have reached 6,171 mg/day, as opposed to 670 mg/day a year earlier. Consequently, renal biopsy was performed, and its result showed collapsing glomerulopathy, compatible with the diagnosis. He has undergone continuous ambulatory peritoneal dialysis as renal replacement therapy. Thus, it is reported herein that a patient clinically diagnosed with chronic kidney disease eight years ago showed a sudden renal-function decrease and was clinicopathologically diagnosed with collapsing glomerulopathy based on the results of his renal biopsy.
Biopsy ; Creatinine ; Glomerulosclerosis, Focal Segmental ; Hematuria ; Humans ; Kidney Failure, Chronic ; Male ; Peritoneal Dialysis, Continuous Ambulatory ; Proteinuria ; Renal Insufficiency, Chronic ; Renal Replacement Therapy

BACKGROUND/AIMS: Autologous stem cell transplantation (ASCT) has become the treatment of choice for patients with multiple myeloma (MM). Studies have shown that maintenance treatment with interferon-alpha is associated with improved survival rates following ASCT. However, despite these recent advances in regimes, relapses are inevitable; thus, the prediction of relapse following ASCT requires assessment. METHODS: We retrospectively analyzed 39 patients who received ASCT between 2003 and 2008. All patients received chemotherapy with vincristine, adriamycin, and dexamethasone (VAD), and ASCT was performed following high-dose melphalan conditioning therapy. We evaluated the influence of the post-transplant day +14 (D+14) bone marrow plasma cell percent (BMPCp) (> or = 2 vs. < 2%), international scoring system (ISS) stage (II vs. III), response after 3 cycles of VAD therapy (complete response [CR] vs. non-CR), deletion of chromosome 13q (del[13q]) (presence of the abnormality vs. absence), and BMPCp at diagnosis (> or = 50 vs. < 50%) on progression-free survival (PFS) and overall survival (OS). RESULTS: During the median follow-up of 28.0 months, the median PFS and OS were 29.1 and 42.1 months, respectively. By univariate analysis, ISS stage III at diagnosis, BMPCp > or = 50% at diagnosis, CR after 3 cycles of VAD therapy, del (13q) by fluorescence in situ hybridization, and BMPCp > or = 2% at post-transplant D+14 were correlated with PFS and OS. A multivariate analysis revealed that a post-transplant D+14 BMPCp > or = 2% (PFS, hazard ratio [HR] = 4.426, p = 0.008; OS, HR = 3.545, p = 0.038) and CR after 3 cycles of VAD therapy (PFS, HR = 0.072, p = 0.014; OS, HR = 0.055, p = 0.015) were independent prognostic parameters. CONCLUSIONS: Post-transplant D+14 BMPCp is a useful parameter for predicting the outcome for patients with MM receiving ASCT.
Adult ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Bone Marrow/*pathology ; Combined Modality Therapy ; Female ; *Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Middle Aged ; Multiple Myeloma/mortality/pathology/*therapy ; Plasma Cells/*pathology ; Predictive Value of Tests ; Retrospective Studies ; Transplantation, Autologous

Endoscopic retrograde biliary drainage (ERBD) is useful for the palliative decompression of biliary obstruction. However, the complications of ERBD include cholangitis, hemorrhage, acute pancreatitis, obstruction of the stent, and duodenal perforation. Pressure necrosis on the duodenal mucosa by the stent may contribute to perforation. Although duodenal perforation following ERBD is very rare compared to other complications, it can result in a fatal outcome. Recent reports describe nonsurgical treatment for small gastrointestinal perforation with localized peritonitis and suggest that endoclipping may be appropriate in the management of a well selected group of patients with iatrogenic perforation. We describe a case of duodenal perforation secondary to ERBD that was successfully treated with approximating using endoclip and detachable snare.
Bile Ducts, Extrahepatic ; Biliary Tract Diseases/complications/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Duodenal Diseases/*diagnosis/etiology/therapy ; Female ; Gallbladder Neoplasms/diagnosis ; Humans ; Intestinal Perforation/*diagnosis/etiology/therapy ; Middle Aged ; Plastics ; Stents/*adverse effects ; Tomography, X-Ray Computed