BACKGROUND: Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. We conducted real-world analysis of HBV prophylaxis after LT in the Korean population.METHODS: Korean Organ Transplantation Registry (KOTRY) database and additionally collected data (n = 326) were analyzed with special reference to types of HBV prophylaxis.RESULTS: The study cohort comprised 267 cases of living-donor LT and 59 cases of deceased-donor LT. Hepatocellular carcinoma (HCC) was diagnosed in 232 (71.2%) of these subjects. Antiviral agents were used in 255 patients (78.2%) prior to LT. HBV DNA was undetectable in 69 cases (21.2%) and detectable over wide concentrations in the other 257 patients (78.8%) prior to LT. Polymerase chain reaction analysis of the store blood samples detected HBV DNA in all patients, with 159 patients (48.9%) showing concentrations > 100 IU/mL. Post-transplant HBV regimens during the first year included combination therapy in 196 (60.1%), hepatitis B immunoglobulin (HBIG) monotherapy in 121 (37.1%), and antiviral monotherapy in 9 (2.8%). In the second post-transplant year, these regimens had changed to combination therapy in 187 (57.4%), HBIG monotherapy in 112 (34.4%), and antiviral monotherapy in 27 (8.3%). Trough antibody to hepatitis B surface antigen titers > 500 IU/mL and >1,000 IU/mL were observed in 61.7% and 25.2%, respectively. The mean simulative half-life of HBIG was 21.6 ± 4.3 days with a median 17.7 days. Up to 2-year follow-up period, HCC recurrence and HBV recurrence developed in 18 (5.5%) and 6 (1.8%), respectively. HCC recurrence developed in 3 of 6 patients with HBV recurrence.CONCLUSION: Combination therapy is the mainstay of HBV prophylaxis protocols in a majority of Korean LT centers, but HBIG was often administered excessively. Individualized optimization of HBIG treatments using SHL is necessary to adjust the HBIG infusion interval.
Antiviral Agents ; Carcinoma, Hepatocellular ; Cohort Studies ; DNA ; Follow-Up Studies ; Half-Life ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B ; Hepatitis ; Humans ; Immunoglobulins ; Korea ; Liver Transplantation ; Liver ; Organ Transplantation ; Polymerase Chain Reaction ; Recurrence ; Transplants

BACKGROUND: Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. We conducted real-world analysis of HBV prophylaxis after LT in the Korean population. METHODS: Korean Organ Transplantation Registry (KOTRY) database and additionally collected data (n = 326) were analyzed with special reference to types of HBV prophylaxis. RESULTS: The study cohort comprised 267 cases of living-donor LT and 59 cases of deceased-donor LT. Hepatocellular carcinoma (HCC) was diagnosed in 232 (71.2%) of these subjects. Antiviral agents were used in 255 patients (78.2%) prior to LT. HBV DNA was undetectable in 69 cases (21.2%) and detectable over wide concentrations in the other 257 patients (78.8%) prior to LT. Polymerase chain reaction analysis of the store blood samples detected HBV DNA in all patients, with 159 patients (48.9%) showing concentrations > 100 IU/mL. Post-transplant HBV regimens during the first year included combination therapy in 196 (60.1%), hepatitis B immunoglobulin (HBIG) monotherapy in 121 (37.1%), and antiviral monotherapy in 9 (2.8%). In the second post-transplant year, these regimens had changed to combination therapy in 187 (57.4%), HBIG monotherapy in 112 (34.4%), and antiviral monotherapy in 27 (8.3%). Trough antibody to hepatitis B surface antigen titers > 500 IU/mL and >1,000 IU/mL were observed in 61.7% and 25.2%, respectively. The mean simulative half-life of HBIG was 21.6 ± 4.3 days with a median 17.7 days. Up to 2-year follow-up period, HCC recurrence and HBV recurrence developed in 18 (5.5%) and 6 (1.8%), respectively. HCC recurrence developed in 3 of 6 patients with HBV recurrence. CONCLUSION Combination therapy is the mainstay of HBV prophylaxis protocols in a majority of Korean LT centers, but HBIG was often administered excessively. Individualized optimization of HBIG treatments using SHL is necessary to adjust the HBIG infusion interval.

BACKGROUND AND PURPOSE: This study investigated the seizure recurrence rate and potential predictors of seizure recurrence following antiepileptic drug (AED) withdrawal after resective epilepsy surgery in children with focal cortical dysplasia (FCD). METHODS: We retrospectively analyzed the records of 70 children and adolescents with FCD types I, II, and IIIa who underwent resective epilepsy surgery between 2004 and 2015 and were followed for at least 2 years after surgery. RESULTS: We attempted AED withdrawal in 40 patients. The median time of starting the AED reduction was 10.8 months after surgery. Of these 40 patients, 14 patients (35%) experienced seizure recurrence during AED reduction or after AED withdrawal. Half of the 14 patients who experienced recurrence regained seizure freedom after AED reintroduction and optimization. Compared with their preoperative status, the AED dose or number was decreased in 57.1% of patients, and remained unchanged in 14.3% after surgery. A multivariate analysis found that incomplete resection (p=0.004) and epileptic discharges on the postoperative EEG (p=0.025) were important predictors of seizure recurrence after AED withdrawal. Over the mean follow-up duration of 4.5 years after surgery, 34 patients (48.6% of the entire cohort) were seizure-free with and without AEDs. CONCLUSIONS: Children with incomplete resection and epileptic discharges on postoperative EEG are at a high risk of seizure recurrence after drug withdrawal. Complete resection of FCD may lead to a favorable surgical outcome and successful AED withdrawal after surgery.
Adolescent ; Anticonvulsants ; Child* ; Electroencephalography ; Epilepsy ; Follow-Up Studies ; Freedom ; Humans ; Malformations of Cortical Development* ; Multivariate Analysis ; Recurrence* ; Retrospective Studies ; Seizures*

PURPOSE: The purpose of this study is to compare the treatment results of fracture fixations by using two minimal invasive techniques for patients with periprosthetic femoral fractures following total knee arthroplasty. MATERIALS AND METHODS: We reviewed 36 patients (5 males, 31 females) of periprosthetic femoral fractures whom were treated surgically between January 2005 and January 2011. Mean patient age was 68.9 years (range, 43 to 81 years) old and the follow-up period averaged 41 months (range, 18 to 72 months). Nineteen patients were treated with minimal invasive locking plate fixations (group I) and 17 patients with retrograde intramedullary nailing (group II). Clinical and radiological outcomes in each group were comparatively analyzed. RESULTS: Successful bone unions occurred in all patients and the mean time to bone union was 3.7 months in group I and 4.2 months in group II. There were no statistical differences between the two groups according to mean operative time and mean intraoperative blood loss. There were also no statistical differences between two groups according to clinical outcomes but the valgus deformity was apparent in group II and radiological outcomes revealed significant differences between the two groups. CONCLUSION: For the treatment of periprosthetic femoral fractures after total knee arthroplasty, two minimal invasive techniques have shown good clinical results. However, the minimal invasive plate fixation showed better results in the radiological alignments.
Arthroplasty* ; Congenital Abnormalities ; Femoral Fractures* ; Follow-Up Studies ; Fracture Fixation ; Fracture Fixation, Intramedullary ; Humans ; Knee* ; Male ; Operative Time ; Periprosthetic Fractures

PURPOSE: Neurogenesis in neonatal period after birth occurs consequently through a series of neuronal stem/progenitor cell proliferation and differentiation. This stage is critical for determining of normal development and maturation of the brain throughout the life. Therefore, exposure to a certain physical or chemical factor(s) during pregnancy can result in serious damage in the developing brain. Bisphenol A (BPA), a plasticizer, is generally known as an endocrine disruptor exhibiting adverse effects when exposed to animals under experimental conditions. The purpose of this study was to investigate the changes in neuronal stem cell proliferation and differentiation during neonatal brain development in BPA-exposed pregnant rats. METHODS: After exposure of BPA to pregnant rats, infant brains were excised at days 3, 7, and 14 after birth, and tissues were processed for histological and biochemical analyses. RESULTS: Proliferating cell nuclear antigen (PCNA) immunostaining showed that whereas cells in the hippocampus at days 3 and 7 after birth were highly proliferating, the cells at day 14 divided less often. Immunohistochemical staining for nestin in the control group revealed that nestin-positive cells were only observed at day 3 after birth, but the immunoreactivity was not observed at day 14. In addition, glial fibrillary acidic protein (GFAP) immunoreactive cells were observed from days 7 to 14 in control tissues. However, in the BPA-exposed groups, 1) the number of PCNA-positive cells in the BPA-exposed groups at days 3 and 7 were higher than those of the control, 2) nestin-positive cells were observed at day 3 which is earlier than that of control, and 3) GFAP-positive cells were detected in the hippocampus tissue from day 3. Furthermore, western blotting showed that exposure to BPA in pregnant rats resulted in earlier expression of nestin in the neuronal rat brain compared to the controls. CONCLUSION: Taken together, it is assumed that precocious neurogenesis in the infant rat hippocampus might be due to BPA exposure during the gestational period. Further studies on adult brain perinatally exposed to BPA are needed to evaluate the pathological status of the hippocampus.
Adult ; Animals ; Benzhydryl Compounds ; Blotting, Western ; Brain ; Cell Proliferation ; Glial Fibrillary Acidic Protein ; Hippocampus ; Humans ; Infant ; Infant, Newborn ; Intermediate Filament Proteins ; Nerve Tissue Proteins ; Neurogenesis ; Neurons ; Parturition ; Phenols ; Plastics ; Pregnancy ; Proliferating Cell Nuclear Antigen ; Rats ; Stem Cells

N-acetyl-L-cysteine (NAC) is a thiol-containing compound and acts as a precursor for glutathione (GSH). It behaves as an antioxidant in mammalian cells and also exerts anti-inflammatory effects. NAC is also known to affect several immune cells including eosinophils, B cells, T cells, and dendritic cells (DC) in many aspects. Even though it has been reported that NAC inhibits DC activation and shifts the immune response to Th2, these studies exhibit some contradictory results in detail and do not give any information with respect to the induction of regulatory T cells. In this study, we re-analyzed the effects of NAC on DC during their activation. We also evaluated whether it induced T cell anergy, Th1/Th2 shift, or regulatory T cells. NAC suppressed the elevation of intracellular reactive oxygen species during DC activation. In parallel, it down-regulated surface expression of CD40 and CD86, suppressed the decrease of phagocytic function, lowered the secretion of cytokines such as IL-6, IL-10, and IL-12. All these effects showed dose-dependency. Thus, it seems likely that NAC inhibited DC activation with regard to their phenotype and cytokine secretion. When we evaluated the T cell-stimulating capacity of these NAC-DC, T cell proliferation and secretion of both Th1 (IFN-gamma) and Th2 cytokine (IL-5) were decreased. This implies that the T cell-stimulating activity of NAC-DC decreased without any shift to Th1 or Th2 cytokine (IL-5). The secretion of IL-10 and TGF-beta in the supernatants were also decreased, which suggests that the decrease of T cell proliferation and cytokine secretion is due to the induction of T cell anergy, rather than regulatory T cells.
Acetylcysteine ; Animals ; B-Lymphocytes ; Cell Proliferation ; Cytokines ; Dendritic Cells ; Eosinophils ; Glutathione ; Interleukin-10 ; Interleukin-12 ; Interleukin-6 ; Mice ; Phenotype ; Reactive Oxygen Species ; T-Lymphocytes ; T-Lymphocytes, Regulatory ; Transforming Growth Factor beta

PURPOSE: Fibrous dysplasia is an uncommon disease that replaces normal bone tissue with fibrous and osteoid tissue. We evaluated patients with fibrous dysplasia involving orbital bones to identify the ocular characteristic findings. METHODS: We recruited 6 patients with fibrous dysplasia of the craniofacial bone. Best corrected visual acuity and facial asymmetry were measured. Slit lamp biomicroscopy, tonometry, strabismus examination, and funduscopy were performed. RESULTS Strabismus, exophthalmos and optic neuropathy were found in 5, 4, and 2 patients, respectively. One patient underwent a strabismus surgery. One patient had McCune-Albright syndrome, exhibiting a cafe-au-lait spot of the skin and precocious puberty. All 6 patients had facial asymmetry and higher superior orbital rims of the affected side in 5 patients. CONCLUSIONS: Ophthalmologic examination may be mandatory for patients with fibrous dysplasia involving the orbit, especially to prevent optic neuropathy. If optic atrophy, strabismus or exophthalmos is found in patients with facial asymmetry, the possibility of fibrous dysplasia must be considered.
Bone and Bones ; Cafe-au-Lait Spots ; Exophthalmos ; Facial Asymmetry ; Fibrous Dysplasia, Polyostotic ; Humans ; Manometry ; Optic Atrophy ; Optic Nerve Diseases ; Orbit ; Puberty, Precocious ; Skin ; Strabismus ; Visual Acuity

PURPOSE: Fibrous dysplasia is an uncommon disease that replaces normal bone tissue with fibrous and osteoid tissue. We evaluated patients with fibrous dysplasia involving orbital bones to identify the ocular characteristic findings. METHODS: We recruited 6 patients with fibrous dysplasia of the craniofacial bone. Best corrected visual acuity and facial asymmetry were measured. Slit lamp biomicroscopy, tonometry, strabismus examination, and funduscopy were performed. RESULTS Strabismus, exophthalmos and optic neuropathy were found in 5, 4, and 2 patients, respectively. One patient underwent a strabismus surgery. One patient had McCune-Albright syndrome, exhibiting a cafe-au-lait spot of the skin and precocious puberty. All 6 patients had facial asymmetry and higher superior orbital rims of the affected side in 5 patients. CONCLUSIONS: Ophthalmologic examination may be mandatory for patients with fibrous dysplasia involving the orbit, especially to prevent optic neuropathy. If optic atrophy, strabismus or exophthalmos is found in patients with facial asymmetry, the possibility of fibrous dysplasia must be considered.
Bone and Bones ; Cafe-au-Lait Spots ; Exophthalmos ; Facial Asymmetry ; Fibrous Dysplasia, Polyostotic ; Humans ; Manometry ; Optic Atrophy ; Optic Nerve Diseases ; Orbit ; Puberty, Precocious ; Skin ; Strabismus ; Visual Acuity

OBJECTIVE: This study was to examine the in vitro neural cell differentiation patterns of human embryonic stem (hES) cells following treatment of various neurotrophic factors [basic fibroblast growth factor (bFGF), retinoic acid (RA), brain derived neurotrophic factor (BDNF) and transforming growth factor (TGF)-alpha], particulary in dopaminergic neuron formation. METHODS: The hES cells were induced to differentiate by bFGF and RA. Group I) In bFGF induction method, embryoid bodies (EBs, for 4 days) derived from hES were plated onto gelatin dish, selected for 8 days in ITSFn medium and expanded at the presence of bFGF (10 ng/ml) for another 6 days followed by a final differentiation in N2 medium for 7, 14 and 21 days. Group II) For RA induction, EBs were exposed of RA (10-6 M) for 4 days and allowed to differentiate in N2 medium for 7, 14 and 21 days. Group III) To examine the effects of additional neurotrophic factors, bFGF or RA induced cells were exposed to either BDNF (10 ng/ml) or TGF-alpha (10 ng/ml) during the 21 days of final differentiation. Neuron differentiation and dopamine secretion were examined by indirect immunocytochemistry and HPLC, respectively. RESULTS: The bFGF or RA treated hES cells were resulted in similar neural cell differentiation patterns at the terminal differentiation stage, specifically, 75% neurons and 11% glial cells. Additionally, treatment of hES cells with BDNF or TGF-alpha during the terminal differentiation stage led to significantly increased tyrosine hydroxylase (TH) expression of a dopaminergic neuron marker, compared to control (p<0.05). In contrast, no effect was observed on the rate of mature neuron (NF-200) or glutamic acid decarboxylase-positive neurons. Immunocytochemistry and HPLC analyses revealed the higher levels of TH expression (20.3%) and dopamine secretion (265.5+/-62.8 pmol/mg) in bFGF and TGF-alpha sequentially treated hES cells than those in RA or BDNF treated hES cells. CONCLUSION: These results indicate that the generation of dopamine secretory neurons from in vitro differentiated hES cells can be improved by TGF-alpha addition in the bFGF induction protocol.
Brain-Derived Neurotrophic Factor ; Cell Differentiation ; Chromatography, High Pressure Liquid ; Dopamine* ; Dopaminergic Neurons ; Embryoid Bodies ; Embryonic Stem Cells* ; Fibroblast Growth Factor 2 ; Fibroblast Growth Factors ; Gelatin ; Glutamic Acid ; Humans* ; Immunohistochemistry ; Nerve Growth Factors* ; Neuroglia ; Neurons* ; Transforming Growth Factor alpha ; Transforming Growth Factors ; Tretinoin ; Tyrosine 3-Monooxygenase

Fibrolipoma is a rare variant of lipomas which shows distinct pathologic findings with both component of mature adipose cells and broad bands of dense fibrous connective tissue. A 52-year-old woman presented with 2X2cm sized, indurated, slightly elevated and slightly tender subcutaneous mass which slowly enlarged during the last four to five years accompanied by slight tenderness on the right upper back. The laboratory examination showed non-specific findings. Histopathologic findings revealed a well-defined mass composed of eosinophilic dense connective tissue bands with mature adipose cells scattered throughout the mass. The lesion was totally excised and she showed no evidence of recurrence after 6 months of follow-up.
Connective Tissue ; Eosinophils ; Female ; Follow-Up Studies ; Humans ; Lipoma ; Middle Aged ; Recurrence