There are limited data on the duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in respiratory specimens after resolution of coronavirus disease 2019 (COVID-19)-associated symptoms/signs. We determined duration of SARS-CoV-2 virus shedding in symptomatic patients after remission of symptoms. We investigated the duration of SARS-CoV-2 RNA detection using real-time reverse transcriptase polymerase chain reaction for SARS-CoV-2 in nasopharyngeal/oropharyngeal swabs or sputum or saliva. Six patients were included in the final analysis. The median (range) duration of SARS-CoV-2 viral detection after hospitalization was 34 days (22 to 67). After resolution of symptoms/signs, SARS-CoV-2 RNA was detected for median (range) of 26 days (9 to 48). Among the six patients, one had persistent detection of SARS-CoV-2 RNA until day 67 of hospitalization, which was 30 days after symptom resolution. This case represents the longest duration of SARS-CoV-2 detection, and highlights the need for long-term follow up of COVID-19 patients despite resolution of symptoms to confirm SARS-CoV-2 clearance.

PURPOSE: Transducin-like enhancer of split 1 (TLE1) is a member of the TLE family of transcriptional co-repressors that control the transcription of a wide range of genes. We investigated the prognostic significance of TLE1 protein expression in breast cancers by using immunohistochemistry and explored the relationship of TLE1 with clinicopathological parameters. METHODS: Immunohistochemistry was performed on 456 cases of breast cancer tiled on tissue microarrays. The relationship between TLE1 expression in normal breast specimens and ductal carcinoma in situ (DCIS) was also analyzed. RESULTS: TLE1 was highly expressed in 57 of 456 (12.5%) carcinoma samples. TLE1 was more frequently expressed in DCIS and invasive breast cancers than in normal breast tissue (p=0.002). High expression of TLE1 significantly correlated with negative lymph node (LN) metastasis (p=0.007), high histologic grade (p<0.001), estrogen receptor negativity (p<0.001), progesterone receptor negativity (p<0.001), human epidermal growth factor receptor 2 (HER2) positivity (p<0.001), and high Ki-67 proliferation index (p<0.001). Based on intrinsic subtypes, high TLE1 expression was strongly associated with HER2+ and triple-negative breast cancers (TNBC) (p<0.001). Survival analysis demonstrated no significant association between TLE1 expression and disease-free survival (DFS) (p=0.167) or overall survival (OS) (p=0.286). In subgroup analyses, no correlation was found between TLE1 expression and DFS or OS according to LN status or intrinsic subtype. CONCLUSION: High TLE1 expression is significantly associated with the HER2+ and TNBC subtypes. This is the first study documenting immunohistochemical expression of TLE1 in invasive breast cancer and its association with clinicopathological parameters, prognosis, and intrinsic subtype.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Co-Repressor Proteins ; Disease-Free Survival ; Estrogens ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Triple Negative Breast Neoplasms

PURPOSE: The aims of this study were to evaluate the expression of the large tumor suppressor (LATS) genes LATS1 and LATS2 by immunohistochemical staining of gastric cancer, and to evaluate the clinicopathological significance of LATS expression and its correlation with overall survival (OS). MATERIALS AND METHODS: LATS1 and LATS2 expression in a tissue microarray was detected by immunohistochemistry, using 264 gastric cancer specimens surgically resected between July 2006 and December 2009. RESULTS: Low expression of LATS1 was significantly associated with more advanced American Joint Committee on Cancer (AJCC) stage (P=0.001) and T stage (P=0.032), lymph node (LN) metastasis (P=0.040), perineural invasion (P=0.042), poor histologic grade (P=0.007), and diffuse-type histology by the Lauren classification (P=0.033). Low expression of LATS2 was significantly correlated with older age (≥65, P=0.027), more advanced AJCC stage (P=0.001) and T stage (P=0.001), LN metastasis (P=0.004), perineural invasion (P=0.004), poor histologic grade (P<0.001), and diffuse-type histology by the Lauren classification (P<0.001). Kaplan-Meier survival analysis revealed significantly poor OS rates in the groups with low LATS1 (P=0.037) and LATS2 (P=0.037) expression. CONCLUSIONS: Expression of LATS1 or LATS2 is a significant marker for a good prognosis in patients with gastric cancer.
Classification ; Genes, Tumor Suppressor ; Humans ; Immunohistochemistry ; Joints ; Long-Acting Thyroid Stimulator ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms*

PURPOSE: The interaction of programmed death receptor 1 (PD-1) and its ligand, programmed death receptor ligand 1 (PD-L1), negatively regulates immune responses. This study aimed to clarify PD-L1 expression levels in breast cancer through immunohistochemistry (IHC) and to evaluate associations between these findings and clinicopathologic variables, including prognosis. METHODS: PD-L1 expression was analyzed using IHC on tissue microarrays of 465 invasive breast carcinomas. RESULTS: High PD-L1 expression was demonstrated in 63 of 465 tumors (13.5%). High PD-L1 expression was significantly associated with high histologic grade (p<0.001), negative lymph nodes (p=0.011), early pathologic stage (p=0.025), high tumor-infiltrating lymphocyte (TIL) (p<0.001) counts, negative estrogen receptor (p<0.001) and progesterone receptor (p=0.002) expression, positive human epidermal growth factor receptor 2 (HER2) (p=0.003), cytokeratin 5/6 (p=0.011), epidermal growth factor receptor (p<0.001), and p53 (p<0.001) expression, and high Ki-67 proliferating index (p<0.001). Based on intrinsic subtypes, high PD-L1 expression and high TIL counts were significantly associated with the HER2 and triple-negative basal type (p<0.001). PD-L1 expression was significantly associated with better disease-free survival (DFS) (p=0.041) and overall survival (OS) (p=0.026) in the univariate analysis, but not in the multivariate analysis. Higher TIL levels was an independent prognostic factor for decreased disease progression (hazard ratio [HR], 2.389; 95% confidence interval [CI], 1.284–4.445; p=0.006) and overall death (HR, 3.666; 95% CI, 1.561–8.607; p=0.003). CONCLUSION: PD-L1 protein expression in breast cancer is associated with better DFS and OS, but is not an independent prognostic factor. High PD-L1 expression was significantly associated with high TIL levels. This finding has important implications for antibody therapies targeting the PD-1/PD-L1 signaling mechanism in breast cancer.
Breast Neoplasms* ; Breast* ; Disease Progression ; Disease-Free Survival ; Estrogens ; Humans ; Immunohistochemistry ; Keratins ; Lymph Nodes ; Lymphocytes, Tumor-Infiltrating* ; Multivariate Analysis ; Prognosis* ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone

BACKGROUND: Acinetobacter baumannii, an opportunistic nosocomial pathogen that can cause significant morbidity and mortality, has emerged as a worldwide problem. The aim of this study was to evaluate the risk factors for mortality in patients with A. baumannii bacteremia. MATERIALS AND METHODS: We retrospectively evaluated 118 patients who had A. baumannii bacteremia between July 2003 and December 2011. The aim of this study was to identify the 30-day mortality in patients with A. baumannii bacteremia and relevant risk factors. RESULTS: The bacteremia-related 30-day mortality rate was 34.1%. Univariate analysis revealed that the risk factors for mortality included malignancy, longer hospital stay before bacteremia, intensive care unit (ICU) stay at the time of bacteremia, mechanical ventilation, use of a central venous catheter, unknown origin of bacteremia, bacteremia due to pneumonia, antimicrobial resistance to carbapenems, and elevated Acute Physiology and Chronic Health Evaluation II and Pitt bacteremia scores. Multivariate logistic regression analysis revealed that resistance to carbapenems (odds ratio [OR]: 4.01, 95% confidence interval [CI]: 1.51 to 0.68, P = 0.005), need for mechanical ventilation (OR: 3.97, 95% CI: 1.41 to 11.13, P = 0.005), and presence of malignancy (OR: 4.40, 95% CI: 1.60 to 12.08, P = 0.004) were significantly related to mortality risk. CONCLUSIONS: Risk factors such as resistance to carbapenems, mechanical ventilation, and presence of malignancy were found to be associated with high mortality rates in the patients with A. baumannii bacteremia.
Acinetobacter ; Acinetobacter baumannii ; APACHE ; Bacteremia ; Carbapenems ; Central Venous Catheters ; Humans ; Intensive Care Units ; Length of Stay ; Logistic Models ; Pneumonia ; Respiration, Artificial ; Retrospective Studies ; Risk Factors

BACKGROUND: Despite advances in microbiological diagnosis and effective antifungal treatment, invasive pulmonary aspergillosis (IPA) is a still major cause of mortality in immunocompromised patients. OBJECTIVE: The aim of this study is to analyze clinical characteristics, treatment outcome and prognostic factors for IPA. METHODS: Between May 2003 and March 2011, we retrospectively studied all patients with IPA in our facility. RESULTS: A total 37 cases were identified. Hematologic malignancies were the leading underlying disease for 27 (27/37, 73.0%) patients. Neutropenic period between the onset of neutropenia and the diagnosis of IPA was 15.0 days. The most common symptom was fever (35/37, 94.6%). The principal findings of chest computed tomography (CT) were segmental or air space consolidation (17/37, 45.9%) followed by halo sign (13/37, 35.1%), and ground-glass attenuation (11/37, 29.7%). Amphotericin B was the initial treatment for 36 (36/37, 97.3%) patients. Voriconazole was subsequently substituted for Amphotericin B in 25 (35/36, 97.2%) patients. The 30-day mortality rate was 24.3% (9/37). The 30-day mortality rate was associated with a failure to recover from neutropenia (p=0.048) or persistent fever during treatment (p=0.003). Two patients were lost to follow-up. Overall mortality was 62.9% (22/35). CONCLUSION: IPA remains a serious condition with failure to recover from neutropenia or persistent fever during treatment associated with a high 30-day mortality rate.
Amphotericin B ; Fever ; Hematologic Neoplasms ; Humans ; Invasive Pulmonary Aspergillosis ; Lost to Follow-Up ; Neutropenia ; Pyrimidines ; Retrospective Studies ; Thorax ; Treatment Outcome ; Triazoles

A 51-year-old man diagnosed with Plasmodium vivax malaria was transferred to our clinic with newly developed drowsy mentality and myoclonus after the initiation of hydroxychloroquine therapy. Following therapy to treat the vivax malaria and supportive care, the patient recovered completely with no sequelae. Cerebral complications caused by vivax malaria are very rare worldwide, and only two cases have been reported in Korea. Here, we report the third published case of P. vivax infection with cerebral complications in Korea.
Humans ; Hydroxychloroquine ; Korea ; Malaria, Cerebral ; Malaria, Vivax ; Middle Aged ; Myoclonus ; Plasmodium ; Plasmodium vivax

BACKGROUND: Patients with malignancy are considered to be at high risk of severe pandemic influenza A/H1N1 2009. This study was conducted to identify the severity of pandemic influenza A/H1N1 2009 among patients with malignancy. MATERIALS AND METHODS: Between August 2009 and December 2009, we reviewed clinical data and medical records of 31 patients with malignancy and 63 hospitalized patients without malignancy. RESULTS: Eighty-three patients with laboratory-confirmed pandemic influenza A/H1N1 2009 were admitted. The rate of ICU admission was higher among patients with malignancy (without malignancy 13% vs with malignancy 35%, P=0.024). The mortality rate was higher among patients with malignancy (without malignancy 6% vs with malignancy 25%, P=0.033). Patients using immunosuppressants showed a higher rate of lower respiratory tract infection (83% vs 24%, P=0.013). CONCLUSIONS: Pandemic influenza A/H1N1 2009 in patients with malignancy was more severe than in patients without malignancy.
Humans ; Immunosuppressive Agents ; Influenza, Human ; Korea ; Medical Records ; Pandemics ; Respiratory Tract Infections

A 51-year-old man diagnosed with Plasmodium vivax malaria was transferred to our clinic with newly developed drowsy mentality and myoclonus after the initiation of hydroxychloroquine therapy. Following therapy to treat the vivax malaria and supportive care, the patient recovered completely with no sequelae. Cerebral complications caused by vivax malaria are very rare worldwide, and only two cases have been reported in Korea. Here, we report the third published case of P. vivax infection with cerebral complications in Korea.
Humans ; Hydroxychloroquine ; Korea ; Malaria, Cerebral ; Malaria, Vivax ; Middle Aged ; Myoclonus ; Plasmodium ; Plasmodium vivax

BACKGROUND: Experimental and clinical studies have suggested that remifentanil probably causes acute tolerance or postinfusion hyperalgesia. This study was designed to confirm whether remifentanil given during propofol anesthesia induced postoperative pain sensitization, and we wanted to investigate whether pregabalin could prevent this pronociceptive effect. METHODS: Sixty patients who were scheduled for total abdominal hysterectomy were randomly allocated to receive (1) a placebo as premedication and an intraoperative saline infusion (control group), (2) a placebo as premedication and an intraoperative infusion of remifentanil at a rate of 3-4 ng/ml (remifentanil group), or (3) pregabalin 150 mg as premedication and an intraoperative infusion of remifentanil at a rate of 3-4 ng/ml (pregabalin-remifentanil group). Postoperative pain was controlled by titration of fentanyl in the postanesthetic care unit (PACU), followed by patient-controlled analgesia (PCA) with fentanyl. The patients were evaluated using the visual analogue scale (VAS) for pain scores at rest and after cough, consumption of fentanyl, sedation score and any side effects that were noted over the 48 h postoperative period. RESULTS: The fentanyl titration dose given in the PACU was significantly larger in the remifentanil group as compared with those of the other two groups. At rest, the VAS pain score in the remifentanil group at 2 h after arrival in the PACU was significantly higher than those in the other two groups. CONCLUSIONS: The results of this study show that remifentanil added to propofol anesthesia causes pain sensitization in the immediate postoperative period. Pretreatment with pregabalin prevents this pronociceptive effect and so this may be useful for the management of acute postoperative pain when remifentanil and propofol are used as anesthetics.
Analgesia, Patient-Controlled ; Anesthesia ; Anesthetics ; Cough ; Fentanyl ; gamma-Aminobutyric Acid ; Humans ; Hyperalgesia ; Hysterectomy ; Pain, Postoperative ; Piperidines ; Postoperative Period ; Premedication ; Propofol ; Pregabalin