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.

BACKGROUND AND OBJECTIVES: Chronic impairment of beta-adrenergic receptor signaling increases cardiac apoptosis, hypertrophy and fibrosis. The aim of this study was to investigate whether isoproterenol (ISO), an agonist of the adrenergic receptor, can enhance tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)-induced apoptosis in human embryonic kidney (HEK) 293 cells. MATERIALS AND METHODS: HEK 293 cells were treated with ISO and/or TRAIL for 24 hours. Cell viability was evaluated by microscopy and an established viability assay, and apoptotic cell death was analyzed by staining with fluorescein isothiocynate-annexin-V/propidium iodide (PI) and caspase activation. To confirm the mechanism of cell death induced by co-treatment with ISO and TRAIL, expression of TRAIL receptor 2 (death receptor 5, DR5) was evaluated by immunoblotting. RESULTS: Although ISO or TRAIL treatment decreased HEK 293 cell viability by 13% and 17%, respectively, co-treatment with ISO and TRAIL resulted in a markedly higher death rate of 35% after 24 hours. Increases were evident in early apoptotic cells (i.e., annexin-V positive/PI negative; 19.4%), late apoptotic cells (i.e., annexin-V positive/PI positive; 6.3%) and dead cells (i.e., annexin-V negative/PI positive; 1.1%) when cells were co-treated with ISO and TRAIL, compared to cells treated with either ISO or TRAIL. In addition, marked increases of cleaved cas-3, cleaved poly (adenosine diphosphate-ribose) polymerase and DR5 were observed in HEK 293 cells co-treated with ISO and TRAIL. CONCLUSION: Treatments combining ISO with TRAIL may be responsible for death of HEK 293 cells through DR5 up-regulation. Activation of adrenergic receptors is responsible for the synergistic cell death observed with TRAIL.
Apoptosis* ; Cell Death ; Cell Survival ; Fibrosis ; Fluorescein ; HEK293 Cells ; Humans* ; Hypertrophy ; Immunoblotting ; Isoproterenol* ; Kidney* ; Microscopy ; Mortality ; Necrosis* ; Receptors, Adrenergic ; Receptors, TNF-Related Apoptosis-Inducing Ligand* ; TNF-Related Apoptosis-Inducing Ligand ; Up-Regulation*

BACKGROUND: The Korean Society for Nosocomial Infection Control (KOSNIC) ran a surveillance system, called as Korean Nosocomial Infections Surveillance (KONIS), since July 2006. Here, we report the annual data of the intensive care unit (ICU) module of the system from July 2012 through June 2013. METHODS: This is a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 161 ICUs in 91 hospitals using the KONIS system. The nosocomial infection (NI) rate was calculated as the number of infections per 1,000 patient days or device days. RESULTS: A total of 3,042 NIs were reported during the study period: 877 UTIs (854 cases were urinary catheter-associated), 1,272 BSIs (1,096 were central line-associated), and 893 PNEUs (526 cases were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 1.26 cases per 1,000 device days (95% confidence interval; 1.18-1.34) and urinary catheter utilization ratio was 0.78 (0.779-0.781). The rate of central line-associated BSIs was 2.57 (2.42-2.72) and the utilization ratio was 0.49 (0.489-0.491). The rate of ventilator-associated PNEUs was 1.64 (1.50-1.78) and the utilization ratio was 0.37 (0.369-0.371). The urinary catheter utilization ratio was lower in the ICUs of hospitals with 400-699 beds than in those of hospitals with more than 900 beds; nevertheless, CAUTIs were more common in the hospitals with 400-699 beds. The central line-associated BSI (CLABSI) rate was lower in the study period than in the previous period of July 2011-June 2012 [2.57 (2.42-2.72) vs. 3.01 (2.84-3.19)]. CONCLUSION: The CLABSI rates were lower in the study period than those in the previous years. CAUTIs were more common in the ICUs of hospitals with 400-699 beds than in those of larger hospitals.
Cross Infection* ; Humans ; Intensive Care Units* ; Critical Care* ; Pneumonia ; Prospective Studies ; Urinary Catheters ; Urinary Tract Infections

BACKGROUND: This article reports annual data of intensive care units (ICU) module of the Korean Nosocomial Infections Surveillance (KONIS) system from July 2011 through June 2012. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 143 ICUs in 81 hospitals using the KONIS system. Nosocomial infection (NI) rates were calculated as the number of infections per 1,000 patient days or device days. Asymptomatic bacteriuria was excluded on or after October 1, 2011. RESULTS: A total of 3,374 NIs were found during the study period: 1,356 UTIs (1,336 cases were urinary catheter-associated), 1,253 BSIs (1,091 were central line-associated), and 765 PNEUs (481 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 2.26 cases per 1,000 device-days (95% confidence interval, 2.14-2.39) and urinary catheter utilization ratio was 0.85 (0.849-0.851). The rate of central line-associated BSIs was 3.01 (2.84-3.19) and the utilization ratio was 0.52 (0.519-0.521). The rate of ventilator-associated PNEUs (VAPs) was 1.70 (1.56-1.86) and the utilization ratio was 0.40 (0.399-0.401). Ventilator and urinary catheter utilization ratios were lower in the ICUs of hospitals with 400-699 beds than those in hospitals with 700-899 beds or more than 900 beds. Nevertheless, VAPs and CAUTIs were more common in hospitals with 400-699 beds. CONCLUSION: Nosocomial infection rates were similar to the findings of those of the previous period, July 2010-July 2011. Implementation of proven infection-control strategies are needed, especially in the hospitals having fewer than 700 beds.
Bacteriuria ; Cross Infection* ; Humans ; Intensive Care Units* ; Pneumonia ; Prospective Studies ; Urinary Catheters ; Urinary Tract Infections ; Ventilators, Mechanical

BACKGROUND: We present here the annual data of the intensive care unit (ICU) module of the Korean Nosocomial Infections Surveillance System (KONIS) from July 2010 through June 2011. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 130 ICUs in 72 hospitals using KONIS. Nosocomial infection (NI) rates were calculated as the number of infections per 1,000 patient-days or device-days. RESULTS: A total of 3,757 NIs were found: 1,978 UTIs (1,949 cases were urinary catheter-associated), 1,092 BSIs (with 932 being central line-associated), and 687 PNEUs (410 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 3.87 cases per 1,000 device-days (95% confidence interval, 3.70-4.05), and the urinary catheter utilization ratio was 0.86 (0.859-0.861). The rate of central line-associated BSIs was 3.01 per 1,000 device-days (2.82-3.21), and the utilization ratio was 0.53 (0.529-0.531). The rate of ventilator-associated PNEUs (VAPs) was 1.75 per 1,000 device-days (1.59-1.93), and the utilization ratio was 0.40 (0.399-0.401). Although both the ventilator utilization ratiosand the urinary catheter utilization ratios were lower in hospitals with 400-699 beds than thosein hospitals with 700-899 beds ormore than 900 beds, the rates of VAPsand CAUTIs were higher in hospitals with 400-699 beds than thosein hospitals with 700-899 beds or more than 900 beds. CONCLUSION: The risk of acquiring VAP and CAUTI is higher in the ICUs of 400-699 bed hospitals than in ICUs oflarger hospitals. Therefore, ongoing targeted surveillance and implementation of proven infection control strategies are needed especially for hospitals having fewer than 700 beds.
Benzamides ; Cross Infection ; Infection Control ; Critical Care ; Intensive Care Units ; Pneumonia ; Prospective Studies ; Urinary Catheters ; Urinary Tract Infections ; Ventilators, Mechanical

Extramedullary plasmacytomas most commonly occur in the nasal cavity, nasopharynx, paranasal sinuses, and larynx. Solitary extramedullary plasmacytoma (SEP) of the thyroid gland is rare. The diagnosis of SEP of the thyroid by cytology is typically difficult before surgery, and the entity is often confused with different cytology findings. We report a case of a 59-year-old man with primary plasmacytoma of the thyroid presented as a rapidly enlarging thyroid gland with Hashimoto's thyroiditis. He had been suffering from anterior neck swelling for 1 month. Several fine-needle aspiration biopsies yielded Hashimoto's thyroiditis. During a follow-up period of 3 years, the size of the thyroid gland increased and a mass lesion in right thyroid gland was detected. A total thyroidectomy was performed based on a diagnosis of a thyroid tumor with Hashimoto's thyroiditis. Permanent pathology identified the mass as an extramedullary plasmacytoma associated with Hashimoto's thyroiditis. Skeletal survey and serum electrophoresis tests were normal, and a bone marrow biopsy yielded no evidence of multiple myeloma. The patient underwent definitive radiotherapy and remained free from any recurrences during follow-up.
Biopsy ; Biopsy, Fine-Needle ; Bone Marrow ; Electrophoresis ; Follow-Up Studies ; Hashimoto Disease ; Humans ; Larynx ; Middle Aged ; Multiple Myeloma ; Nasal Cavity ; Nasopharynx ; Neck ; Paranasal Sinuses ; Plasmacytoma ; Recurrence ; Stress, Psychological ; Thyroid Gland ; Thyroidectomy ; Thyroiditis

OBJECTIVES: To investigate the occurring characteristics of pulmonary tuberculosis (TB) among nurses working at a university hospital in Korea. METHODS: A retrospective cohort study was conducted using medical records from a university hospital. A total of 351 nurses without any pulmonary disease were enrolled during 2000~2007, and were followed up until October 2010. To compare with the incidence of TB between occupational subgroups, workplaces were divided into high and low TB-exposure risk departments. For statistical analysis, the relative risks for TB incidences between departments were estimated using Cox proportional hazards models and mean incidences were estimated with person-time years. RESULTS: Seven cases of TB were observed during 2001 person-years. Five and two cases were observed in the high and low TB-exposure risk departments, respectively. The relative risk of TB infection in the high TB-exposure risk departments were 6.52 (95% CI, 1.26~33.60) compared to that in the low TB-exposure risk department. The mean incidence of TB in the total nurses was 0.350% per person-year. CONCLUSIONS: According to the concept of occupational and environmental medicine, high TB-exposure risk departments were more likely to be at increased risk of tuberculosis.
Cohort Studies ; Environmental Medicine ; Hospital Departments ; Incidence ; Lung Diseases ; Medical Records ; Proportional Hazards Models ; Retrospective Studies ; Tuberculosis ; Tuberculosis, Pulmonary

Wegener's granulomatosis is a rare disease that pathologically causes necrotizing granulomatous vasculitis in the arterioles and venules and it can invade the whole body. In addition, it is difficult to distinguish between a nontuberculous mycobacteria infection that shows manifestations of granuloma and Wegener's granulomatosis. There has been no reported on a patient who had the 2 abovementioned two diseases at the same time. A 69 year old male patient had Wegener's granulomatosis that had invaded the prostate. He also had a scrotal swelling and back pain. He had manifestations of granulomatous infection on the scrotum and spine biopsies. However, there was no clinical evidence of Wegener's granulomatosis. As a result, we examined him for other diseases that can cause a granuloma. Consequently, he was also diagnosed as suffering with a nontuberculous mycobacteria infection. We report here on this case and we review the relevant medical literature.
Arterioles ; Back Pain ; Biopsy ; Granuloma ; Humans ; Male ; Nontuberculous Mycobacteria ; Prostate ; Rare Diseases ; Scrotum ; Spine ; Stress, Psychological ; Vasculitis ; Venules ; Wegener Granulomatosis

AIMS: The left colon receives its arterial supply from the inferior mesenteric artery (IMA). The detailed anatomical understanding of IMA is important for sigmoid colon or rectal cancer surgery. The aim of this study is to investigate the vascular anatomy of the IMA by measuring the distance from the aortic bifurcation and the length of the IMA in autopsy cases. METHODS: 41 consecutive autopsy cases were enrolled prospectively. 29 cases were males and 12 females. Mean age was 47.7+/-15.6 with a range of 12 to 82 years. The distance from the aortic bifurcation is measured between the angle of abdominal aortic bifurcation and the inferior margin of the IMA. The length of the IMA is measured between the root of the IMA and the proximal border of the first branch of the IMA. Mann-Whitney U test, Pearson's correlation coefficient, and Spearman's rho were used for statistical analysis. RESULTS: The distance from the aortic bifurcation ranged from 3 to 6.3 cm with a mean of 4.4+/-0.71 cm. The length of the IMA ranged from 2.5 to 7 cm with a mean of 4+/-0.8 cm. The distance from the aortic bifurcation and the length of the IMA had no correlations with subject's height and weight. CONCLUSIONS: The vascular anatomy of the IMA in the general population is an important information for colorectal surgeon. Clear anatomical understanding of IMA may help perform oncologically safe colorectal surgery.
Autopsy* ; Colon ; Colon, Sigmoid ; Colorectal Surgery ; Female ; Humans ; Male ; Mesenteric Artery, Inferior* ; Prospective Studies ; Rectal Neoplasms ; Rectum ; Statistics, Nonparametric

The application of DNA typing method after amplification by the polymerase chain reaction (PCR) of DNA derived from bone from two missing persons. In this case, short tandem repeats (STR) are used. The AmpFlSTR Identifiler loci (amelogenin and 15 STRs) are analysed by multiplex-PCR and automated fluorescent detection using Perkin Elmer Prism 310 DNA sequencer.
DNA ; DNA Fingerprinting ; Humans ; Microsatellite Repeats ; Polymerase Chain Reaction