Objective: To evaluate the prevalence and prognostic role of programmed death ligand 1 (PDL1) expression and tumor mutational burden (TMB) in patients with non-immunotherapytreated advanced cervical cancer. Methods: Clinical data were retrospectively collected from medical records between January 1, 2008, and December 31, 2016, at Asan Medical Center (Korea); archived tumor samples were assessed for PD-L1 expression (combined positive score [CPS] ≥1) and TMB (≥175 mutations/exome). Overall survival (OS) was defined as time from advanced diagnosis or initiation of first-line or second-line systemic therapy until death/last follow-up. The association of OS with PD-L1 expression and TMB were analyzed using the log-rank test and Cox proportional hazards model adjusted for covariates. Results: Of 267 patients, 76.0% had squamous cell carcinoma (SCC), 24.0% had adenocarcinoma (AC)/adenosquamous carcinoma (ASC), 64.4% had PD-L1 CPS ≥1, and 32.6% had TMB ≥175 mutations/exome. PD-L1 CPS ≥1 and TMB ≥175 mutations/exome were more prevalent in SCC than in AC/ASC (73.9% and 37.2% vs. 34.4% and 17.7%). There was no association between OS and PD-L1 expression (CPS ≥1 vs. <1: adjusted hazard ratio [HR]=1.14; 95% confidence interval [CI]=0.84–1.53 from advanced diagnosis); OS trended shorter for the subgroup with TMB ≥175 versus <175 mutations/exome (adjusted HR=1.29;95% CI=0.95–1.75). Conclusion Retrospective analysis of non-immunotherapy-treated patients with advanced cervical cancer demonstrated a higher prevalence of PD-L1 CPS ≥1 and TMB ≥175 mutations/ exome in SCC versus AC/ASC. PD-L1 CPS ≥1 was not associated with OS; TMB ≥175 mutations/exome showed a trend toward shorter OS. Additional studies are needed to confirm these findings.

Objective: To evaluate the prevalence and prognostic role of programmed death ligand 1 (PDL1) expression and tumor mutational burden (TMB) in patients with non-immunotherapytreated advanced cervical cancer. Methods: Clinical data were retrospectively collected from medical records between January 1, 2008, and December 31, 2016, at Asan Medical Center (Korea); archived tumor samples were assessed for PD-L1 expression (combined positive score [CPS] ≥1) and TMB (≥175 mutations/exome). Overall survival (OS) was defined as time from advanced diagnosis or initiation of first-line or second-line systemic therapy until death/last follow-up. The association of OS with PD-L1 expression and TMB were analyzed using the log-rank test and Cox proportional hazards model adjusted for covariates. Results: Of 267 patients, 76.0% had squamous cell carcinoma (SCC), 24.0% had adenocarcinoma (AC)/adenosquamous carcinoma (ASC), 64.4% had PD-L1 CPS ≥1, and 32.6% had TMB ≥175 mutations/exome. PD-L1 CPS ≥1 and TMB ≥175 mutations/exome were more prevalent in SCC than in AC/ASC (73.9% and 37.2% vs. 34.4% and 17.7%). There was no association between OS and PD-L1 expression (CPS ≥1 vs. <1: adjusted hazard ratio [HR]=1.14; 95% confidence interval [CI]=0.84–1.53 from advanced diagnosis); OS trended shorter for the subgroup with TMB ≥175 versus <175 mutations/exome (adjusted HR=1.29;95% CI=0.95–1.75). Conclusion Retrospective analysis of non-immunotherapy-treated patients with advanced cervical cancer demonstrated a higher prevalence of PD-L1 CPS ≥1 and TMB ≥175 mutations/ exome in SCC versus AC/ASC. PD-L1 CPS ≥1 was not associated with OS; TMB ≥175 mutations/exome showed a trend toward shorter OS. Additional studies are needed to confirm these findings.

Objective: To evaluate the prevalence and prognostic role of programmed death ligand 1 (PDL1) expression and tumor mutational burden (TMB) in patients with non-immunotherapytreated advanced cervical cancer. Methods: Clinical data were retrospectively collected from medical records between January 1, 2008, and December 31, 2016, at Asan Medical Center (Korea); archived tumor samples were assessed for PD-L1 expression (combined positive score [CPS] ≥1) and TMB (≥175 mutations/exome). Overall survival (OS) was defined as time from advanced diagnosis or initiation of first-line or second-line systemic therapy until death/last follow-up. The association of OS with PD-L1 expression and TMB were analyzed using the log-rank test and Cox proportional hazards model adjusted for covariates. Results: Of 267 patients, 76.0% had squamous cell carcinoma (SCC), 24.0% had adenocarcinoma (AC)/adenosquamous carcinoma (ASC), 64.4% had PD-L1 CPS ≥1, and 32.6% had TMB ≥175 mutations/exome. PD-L1 CPS ≥1 and TMB ≥175 mutations/exome were more prevalent in SCC than in AC/ASC (73.9% and 37.2% vs. 34.4% and 17.7%). There was no association between OS and PD-L1 expression (CPS ≥1 vs. <1: adjusted hazard ratio [HR]=1.14; 95% confidence interval [CI]=0.84–1.53 from advanced diagnosis); OS trended shorter for the subgroup with TMB ≥175 versus <175 mutations/exome (adjusted HR=1.29;95% CI=0.95–1.75). Conclusion Retrospective analysis of non-immunotherapy-treated patients with advanced cervical cancer demonstrated a higher prevalence of PD-L1 CPS ≥1 and TMB ≥175 mutations/ exome in SCC versus AC/ASC. PD-L1 CPS ≥1 was not associated with OS; TMB ≥175 mutations/exome showed a trend toward shorter OS. Additional studies are needed to confirm these findings.

Pituitary insufficiency due to a sellar aneurysm is relatively uncommon. The prevalence of this disorder was <0.2% in a large cohort of patients with panhypopituitarism. While uncommon, a vascular sellar lesion should be included as a differential diagnosis for a sellar mass resulting in hypopituitarism. We report herein a case of hypopituitarism with hyperprolactinemia secondary to a large (1.7-cm) saccular aneurysm at the left paraclinoid internal carotid artery.
Aneurysm* ; Carotid Artery, Internal* ; Cohort Studies ; Diagnosis, Differential ; Humans ; Hyperprolactinemia ; Hypopituitarism* ; Prevalence

Four trials of external quality assessment in diagnostic hematology were performed in 2008 with average 822 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, hematocrit, red blood cell count, platelet count, blood cell morphology, prothrombin time and activated partial thromboplastin time. The response rate was more than 96.5%. The coefficients of variation in hemoglobin, hematocrit and RBC was stable but variable in platelet count and WBC count according to measuring cell count. Test results of blood cell morphology showed variation among various cell morphologies.
Blood Cells ; Cell Count ; Erythrocyte Count ; Hematocrit ; Hematology ; Hemoglobins ; Korea ; Leukocyte Count ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time

Neonatal alloimmune thrombocytopenia (NAIT) is induced by maternal antibodies to fetal platelet alloantigens. Because the main cause of NAIT is incompatibility to platelet specific antibodies, NAIT due to HLA antibodies are relatively rare. We managed a case of NAIT induced by maternal anti-HLA-B35 antibodies. The patient was a second born male. He had no petechiae or purpura at birth. He was admitted to the hospital due to fever for 5 days and a platelet count of 106x10(9)/L. The fever subsided after admission but on the 2nd day of admission, petechiae developed on the chest wall and the platelet count decreased to 25x10(9)/L. Other laboratory findings included C-reactive protein, prothrombin time, and partial thromboplastin time were normal. His mother's platelet count was normal and she had no history of bleeding. Anti-HLA-B35, B52, B56, C3, and C14 were identified in the mother's serum by a panel reactive antibody test and HLA-B35 antigen was identified in the father's and patient's sera. These finding suggested that maternal Anti-HLA-B35 antibody was a response to neonatal HLA-B35 antigen inherited from the father. The patient received concentrated platelet and intravenous immunoglobulin. The platelet count rose to 248x10(9)/L and was maintained thereafter.
Antibodies ; Antigens, Human Platelet ; Blood Platelets ; C-Reactive Protein ; Fathers ; Fever ; Hemorrhage ; HLA-B35 Antigen ; Humans ; Immunoglobulins ; Male ; Partial Thromboplastin Time ; Parturition ; Platelet Count ; Prothrombin Time ; Purpura ; Thoracic Wall ; Thrombocytopenia, Neonatal Alloimmune

BACKGROUND: Activation of renin-angiotensin system (RAS) has been an important mechanism of microvascular and macrovascular complications in diabetic patients. It has been reported that RAS blockades reduce the development and progression of diabetic nephropathy. The aim of this study was to evaluate whether valsartan, an angiotensin II receptor blocker (ARB), reduced blood pressure and urinary albumin excretion rate (UAER) in hypertensive type 2 diabetic patients. METHOD: Three hundred forty-seven hypertensive type 2 diabetic patients who had not taken angiotensin converting enzyme inhibitors or ARB for 6 months prior to this study were enrolled. We measured blood pressure and UAER before and after 24 weeks of valsartan treatment. RESULT: Baseline mean systolic and diastolic blood pressure was 143 +/- 15 and 87 +/- 11 mmHg, respectively and the median albumin excretion rate was 27 ug/mg. Reduction in systolic and diastolic blood pressure was 16 mmHg/10 mmHg and the median UAER was 19.3 ug/mg after 24 weeks (P < 0.01, respectively). When we divided the subjects into three groups according to the UAER (normoalbuminuria, microalbuminuria and macroalbuminuria), significant changes were reported in the microalbuminuria and the macroalbuminuria groups. Thirty-eight (42%) patients with microalbuminuria improved to normoalbuminuria and twelve (41%) patients with macroalbuminuria improved to microalbuminuria. We found an association between the improvement of blood pressure and UAER (R = 0.165, P = 0.015). CONCLUSION: We concluded that valsartan reduces urinary albumin excretion and blood pressure in hypertensive type 2 diabetic patients.
Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; Blood Pressure ; Diabetes Mellitus ; Diabetic Nephropathies ; Humans ; Receptors, Angiotensin ; Renin-Angiotensin System ; Tetrazoles ; Valine ; Valsartan

Mycobacterium marinum is a nontuberculous mycobacterium responsible for skin infection. Risk factors include a history of trauma and water/fish-related hobbies or occupations. This infection is characteristically limited to the skin but deep soft tissue may be involved. We report a case of M. marinum infection in a 51-year-old man with ulcer and erythematous nodules on his right hand. The patient owned a tropical fish tank and remembered having previous hand trauma. The lesions extended to his forearm and formed sporotrichoid appearance. M. marinum was isolated from tissue specimens. The patient was treated with rifampin, etambutol and clarithromycin for 5 months, then the skin lesions were cured. The key to the diagnosis of this case are clinical awareness and a detailed history. M. marinum infection should be considered in chronic sporotrichoid skin lesions, particularly when there is a clinical suspicion on an infectious cause, and it could lead to successful treatment.
Clarithromycin ; Diagnosis ; Forearm ; Hand ; Hobbies ; Humans ; Middle Aged ; Mycobacterium marinum* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Occupations ; Rifampin ; Risk Factors ; Skin ; Ulcer

Mycobacterium marinum is a nontuberculous mycobacterium responsible for skin infection. Risk factors include a history of trauma and water/fish-related hobbies or occupations. This infection is characteristically limited to the skin but deep soft tissue may be involved. We report a case of M. marinum infection in a 51-year-old man with ulcer and erythematous nodules on his right hand. The patient owned a tropical fish tank and remembered having previous hand trauma. The lesions extended to his forearm and formed sporotrichoid appearance. M. marinum was isolated from tissue specimens. The patient was treated with rifampin, etambutol and clarithromycin for 5 months, then the skin lesions were cured. The key to the diagnosis of this case are clinical awareness and a detailed history. M. marinum infection should be considered in chronic sporotrichoid skin lesions, particularly when there is a clinical suspicion on an infectious cause, and it could lead to successful treatment.
Clarithromycin ; Diagnosis ; Forearm ; Hand ; Hobbies ; Humans ; Middle Aged ; Mycobacterium marinum* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Occupations ; Rifampin ; Risk Factors ; Skin ; Ulcer

BACKGROUND: Serum potassium level assessment is one of the commonly requested laboratory tests. Hypokalemia is defined as a serum potassium level of less than 3.5 mEq/L. It can be potentially life-threatening when severe, due to its association with cardiac arrhythmia and sudden deaths. The aim of our study is to determine the prevalence and to define clinical characteristics of severe hypokalemia in internal medicine hospitalized patients. METHODS: From December 1999 to June 2000, the group with at least one recorded plasma potassium concentration of less than 3.0 mEq/L was selected in department of internal medicine, Pusan national university hospital. Routine records of age, sex and prevalence was collected. Severe hypokalemia is defined as a serum potassium concentration less than 2.6 mEq/L. This patients were retrospectively studied for discharge diagnosis, medications prescribed before and during hospital stay, hospital course and laboratory findings. RESULTS: There were 7.52% (235/3124) with at least one recorded potassium level of less than 3.0 mEq/L. Severe hypokalemia were 75 patients (2.4%). It were more likely to be female, but statically insignificant. Of the 75 patients, 59 patients (77.3%) had hypokalemia during hospitalization. Gastrointestinal loss of potassium was only 13.8% of the patients. The main causes were combination of iatrogenic factors, including the adminstration of intravenous fluids with insufficient or no potassium, malnutrition, and several drugs. The discharge diagnosis included infection 20 patients (26.6%), malignancy 19 patients (25.3%), gastointestinal disorders 8 patients (10.6%). And each of cardiovascular, respiratory and renal disorders have 7 patients (9.3%). In-hospital mortality was 34.6% (26/75) in severe hypokalemia. Compared to the alive group, death group showed statically significant decrease in serum albumin concentration (p<0.05). CONCLUSION: Severe hypokalemia is fatal electrolyte disorder. The most frequent cause of this lethal condition is drug therapy and intravenous fluids with insufficient or no potassium replacement. It can be prevented by regular potassium monitoring and appropriate potassium supplementation in risky hospitalized patients.
Arrhythmias, Cardiac ; Busan ; Death, Sudden ; Diagnosis ; Drug Therapy ; Female ; Hospital Mortality ; Hospitalization ; Humans ; Hypokalemia* ; Internal Medicine* ; Length of Stay ; Malnutrition ; Plasma ; Potassium ; Prevalence ; Retrospective Studies ; Serum Albumin