Background: and Purpose We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion. Methods: Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization. Results: Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032). Conclusions The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.

Background: and Purpose We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion. Methods: Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization. Results: Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032). Conclusions The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.

BACKGROUND AND PURPOSE: To compare the efficacy and safety of antiplatelet agents for the secondary prevention of ischemic stroke based on cytochrome P450 2C19 (CYP2C19) polymorphisms. METHODS: This study was a prospective, multicenter, randomized, parallel-group, open-label, blind genotype trial. First time non-cardiogenic ischemic stroke patients were enrolled and screened within 30 days. Participants were randomized to receive either triflusal or clopidogrel for secondary stroke prevention. The primary outcome was the time from randomization to first recurrent ischemic stroke or hemorrhagic stroke. RESULTS: The required sample size was 1,080 but only 784 (73%) participants were recruited. In patients with a poor CYP2C19 genotype for clopidogrel metabolism (n=484), the risk of recurrent stroke among those who received triflusal treatment was 2.9% per year, which was not significantly different from those who received clopidogrel treatment (2.2% per year; hazard ratio [HR], 1.23; 95% confidence interval [CI], 0.60–2.53). In the clopidogrel treatment group (n=393), 38% had good genotypes and 62% poor genotypes for clopidogrel metabolism. The risk of recurrent stroke in patients with a good CYP2C19 genotype was 1.6% per year, which was not significantly different from those with a poor genotype (2.2% per year; HR, 0.69; 95% CI, 0.26–1.79). CONCLUSIONS: Whilst there were no significant differences between the treatment groups in the rates of stroke recurrence, major vascular events, or coronary revascularization, the efficacy of antiplatelet agents for the secondary prevention of stroke according to CYP2C19 genotype status remains unclear.
Cytochrome P-450 CYP2C19 ; Cytochrome P-450 Enzyme System* ; Cytochromes* ; Genotype ; Humans ; Metabolism ; Platelet Aggregation Inhibitors ; Prospective Studies ; Random Allocation ; Recurrence ; Sample Size ; Secondary Prevention* ; Stroke*

PURPOSE: To evaluate the clinical spectrum of posttransplantation lymphoproliferative disorder (PTLD) after solid organ transplantation (SOT) in children. METHODS: We retrospectively reviewed the medical records of 18 patients with PTLD who underwent liver (LT) or kidney transplantation (KT) between January 1995 and December 2014 in Seoul National University Children's Hospital. RESULTS: Eighteen patients (3.9% of pediatric SOTs; LT:KT, 11:7; male to female, 9:9) were diagnosed as having PTLD over the last 2 decades (4.8% for LT and 2.9% for KT). PTLD usually presented with fever or gastrointestinal symptoms in a median period of 7 months after SOT. Eight cases had malignant lesions, and all the patients except one had evidence of Epstein-Barr virus (EBV) involvement, assessed by using in situ hybridization of tumor tissue or EBV viral load quantitation of blood. Remission was achieved in all patients with reduction of immunosuppression and/or rituximab therapy or chemotherapy, although 1 patient had allograft kidney loss and another died from complications of chemotherapy. The first case of PTLD was encountered after the introduction of tacrolimus for pediatric SOT in 2003. The recent increase in PTLD incidence in KT coincided with modification of clinical practice since 2012 to increase the tacrolimus trough level. CONCLUSION: While the outcome was favorable in that all patients achieved complete remission, some patients still had allograft loss or mortality. To prevent PTLD and improve its outcome, monitoring for EBV infection is essential, which would lead to appropriate modification of immunosuppression and enhanced surveillance for PTLD.
Allografts ; Child ; Drug Therapy ; Epstein-Barr Virus Infections ; Female ; Fever ; Herpesvirus 4, Human ; Humans ; Immunosuppression ; In Situ Hybridization ; Incidence ; Kidney ; Kidney Transplantation ; Liver ; Lymphoproliferative Disorders* ; Male ; Medical Records ; Mortality ; Organ Transplantation* ; Retrospective Studies ; Rituximab ; Seoul ; Tacrolimus ; Transplants* ; Viral Load

Pig pancreas may be a therapeutic resource for human diabetic patients. However, this potential is hindered by a lack of knowledge of the molecular events of pig pancreas development. In this study, the embryonic day 60, neonate and 6-month protein profiles of pig pancreas were ascertained at using two-dimensional gel electrophoresis and matrix assisted laser desorption/ionization-time of flight mass spectrometry. Twenty four proteins were differentially expressed during pig pancreas development. Among them, 12 spots increased and 7 spots decreased according to development. The expression of 5 protein were highest at birth. Expression of digestive enzymes including trypsin, pancreatic triacylglycerol lipase and pancreatic alpha-amylase was elevated in adults, whereas chymotrypsins were highly expressed in neonates. Proteins that were abundantly expressed during gestation were alpha-1-antitrypsin, alpha-fetoprotein and transferrins. Taken together, we found out that several proteins were significantly up- or down- regulated from pig pancreas based on developmental stage. This study will provide basis for understanding development of pig pancreas.
Adult ; alpha-Amylases ; alpha-Fetoproteins ; Chymotrypsin ; Electrophoresis* ; Electrophoresis, Gel, Two-Dimensional ; Humans ; Infant, Newborn ; Lipase ; Mass Spectrometry* ; Pancreas* ; Parturition ; Pregnancy ; Sus scrofa* ; Transferrin ; Transferrins ; Trypsin

OBJECTIVES: This study compared attitudes toward antipsychotic treatment according to awareness of the name of their illness in patients with schizophrenia. METHODS: Information on sociodemographic and clinical characteristics, including awareness of the importance of antipsychotic treatment, was obtained through a self-report questionnaire. The Drug Attitude Inventory (DAI) was administered. The data were compared according to awareness of the name of their illness. RESULTS: The study analyzed data for 199 patients with schizophrenia. Of these, 115 patients (57.8%) were aware that their illness was called schizophrenia, while 84 patients (42.2%) knew it by their psychotic symptoms or as another mental illness, such as depression. The patients aware of the name of their illness had significantly longer durations of illness and higher scores on the DAI. They were significantly more likely to have stopped taking medication on their own accord and to agree with the importance of antipsychotic treatment. Statistical significance was sustained in a logistic regression analysis after adjusting for the duration of illness and study site, except for the DAI score, which had borderline significance (p=0.055). In subjects with duration of illness > or =5 years, patients aware of the name of their illness had significantly higher scores on the DAI. CONCLUSION: Awareness of the name of their illness was associated with awareness of the importance of, and a positive attitude toward, antipsychotic treatments in patients. Psycho-education, including telling the patient the correct name of his or her illness, might be needed for maintaining antipsychotic treatment in patients with chronic schizophrenia.
Antipsychotic Agents ; Depression ; Humans ; Logistic Models ; Surveys and Questionnaires ; Schizophrenia

Congenital nephrotic syndrome is defined as nephrotic syndrome which manifests in utero or during the first 3 months of life. The prototype of congenital nephrotic syndrome is congenital nephrotic syndrome of Finnish type (CNF, OMIM #602716), which is caused by loss-of-function mutations of the nephrin gene (NPHS1). There have been few clinical case reports of CNF in Korea, but none of which was confirmed by genetic study. Here, we report two children with congenital nephrotic syndrome. Genetic analysis of the NPHS1 gene revealed compound heterozygous frame-shifting mutations (c.2156_2163 delTGCACTGC causing p.L719DfsX4 and c.3250_3251insG causing p.V1084GfsX12) in one patient and a missense mutation (c.1381G>A causing p.R460Q) and a nonsense mutation (c.2442C>G causing p.Y814X) in the other patient. The nonsense mutation was novel. The clinical courses of the patients were typical of CNF. This is the first report of genetically confirmed CNF in Korea to date. The early genetic diagnosis of CNF is important for proper clinical management of the patients and precise genetic counseling of the families.
Base Sequence ; Biopsy ; Codon, Nonsense ; Female ; Frameshift Mutation ; Humans ; Infant ; Infant, Newborn ; Korea ; Male ; Membrane Proteins/*genetics ; Microscopy, Electron/methods ; Molecular Sequence Data ; Mutation ; Nephrotic Syndrome/*diagnosis/*genetics

Risperdal Consta is the first long-acting intramuscular formulation of an atypical antipsychotic. It is frequently used to treat schizophrenia, but its safety for use during pregnancy has not been established. We report four cases of patients with schizophrenia or schizoaffective disorder who took Risperdal Consta during pregnancy. None of the babies born from these four patients had any congenital malformation and all exhibited healthy postnatal development. This paper presents the rationale for the use of antipsychotics including Risperdal Consta during pregnancy and the related problems through a literature review. This serial case report contributes to the body of knowledge regarding the use of antipsychotics during pregnancy.
Antipsychotic Agents ; Humans ; Pregnancy ; Psychotic Disorders ; Risperidone ; Schizophrenia

Risperdal Consta is the first long-acting intramuscular formulation of an atypical antipsychotic. It is frequently used to treat schizophrenia, but its safety for use during pregnancy has not been established. We report four cases of patients with schizophrenia or schizoaffective disorder who took Risperdal Consta during pregnancy. None of the babies born from these four patients had any congenital malformation and all exhibited healthy postnatal development. This paper presents the rationale for the use of antipsychotics including Risperdal Consta during pregnancy and the related problems through a literature review. This serial case report contributes to the body of knowledge regarding the use of antipsychotics during pregnancy.
Antipsychotic Agents ; Humans ; Pregnancy ; Psychotic Disorders ; Risperidone ; Schizophrenia

PURPOSE: To assess the current status of endourology and laparoscopy in Korea. MATERIALS AND METHODS: Using the database directory of the Korean Urological Association, 83 urology training hospitals were identified. A detailed questionnaire was designed and sent by post and e-mail. The questionnaire included questions regarding the number of various endourological and laparoscopic procedures between 1998 and 2002. The questionnaires of those responding were analyzed. RESULTS: Responses were received from 45 hospitals (response rate 54.2%). 133 antegrade and 626 retrograde endourological procedures for urinary strictures were performed during the period of the study in 12 and 35 hospitals, respectively. 42 hospitals (93.3%) were performing shock wave lithotripsy for urinary stone disease. 29 hospitals (64.4%) reported having performed more than one laparoscopic procedure during the five years. The annual total numbers of laparoscopic procedures increased from 217 in 1998 to 725 in 2002. Simple laparoscopic nephrectomy was the most widely accepted procedure, and was being performed in 18 hospitals. Laparoscopic adrenalectomy, radical nephrectomy, diagnostic laparoscopy, laparoscopic renal cyst marsupialization, nephroureterectomy and donor nephrectomy were performed in more than 10 hospitals. However, the actual number of laparoscopic procedures was limited in most hospitals. More than 40 laparoscopic procedures per year were performed by only four hospitals. CONCLUSIONS: This survey revealed an increasing number of endourological and laparoscopic procedures. However, laparoscopy seems to be mainly a larger hospital-based technology in Korea. These results can be utilized as fundamental data for establishing future developmental requirements of endourology and laparoscopy in Korea.
Adrenalectomy ; Constriction, Pathologic ; Electronic Mail ; Endoscopy ; Humans ; Korea ; Laparoscopy* ; Lithotripsy ; Nephrectomy ; Surveys and Questionnaires ; Shock ; Surgical Procedures, Minimally Invasive ; Tissue Donors ; Urinary Calculi ; Urology*