Herein, we report the results of the 2018 survey on the external quality assessment (EQA) scheme for the Transfusion Medicine Program (TMP) in Korea. The proficiency testing specimens were prepared at Ajou University Hospital and were sent to the participants biannually. The average accuracy rates for ten different test items on the regular survey were as follows: ABO typing, 99.5%–99.8% (N=841); RhD typing, 99.8%–100.0% (N=827); crossmatching, 89.4%–99.6% (N=708); ABO subtyping, 94.2% and 94.4% (N=53); Rh CcEe antigen testing, all 100.0% (N=51); weak D test, 80.9% (N=207) for the first trial and not graded for the second trial; antibody screening, 99.7%–100.0% (N=304); direct antiglobulin test (DAT) using a polyspecific reagent, 98.9%–100.0% (N=264); DAT using an immunoglobulin-G monospecific reagent, all 100.0% (N=66); DAT using a C3d monospecific reagent, 97.0%–100.0% (N=67); antibody identification, 98.4%–100.0% (N=127); and ABO antibody titration, 84.6%–100.0% (N=73). There were approximately 10.5% more participants in the 2018 EQA scheme than that in 2017. Excellent survey results were obtained in the 2018 EQA scheme compared with those in 2017, except for the weak D test. The 2018 EQA scheme for the TMP should be helpful for improving the quality of the participating laboratories.
Coombs Test ; Korea ; Laboratory Proficiency Testing ; Mass Screening ; Quality Improvement ; Thymidine Monophosphate ; Transfusion Medicine

Here, we have reported results of the surveys on the external quality assessment scheme (EQA) of the Transfusion Medicine Program (TMP) in Korea that were carried out in 2017. The proficiency testing specimens were prepared at Ajou University Hospital, and sent to the participants biannually. The average accuracy rates (N=the number of participants) for ten different test items on the regular survey were as follows: ABO typing, 99.1%–99.9% (N=714); RhD typing, 99.3%–100.0% (N=695); crossmatching, 88.9%–98.5% (N=618); ABO subtyping, 80.7% and 96.0% (N=51); Rh CcEe antigen testing, 98.8%–100.0% (N=51); weak D test, 99.3% and 100.0 (N=150); antibody screening, 98.6%–100.0% (N=295); direct antiglobulin test (DAT) using a poly-specific reagent, 99.2%–100.0 (N=256); DAT using an immunoglobulin-G monospecific reagent, all 100.0% (N=68); DAT using a C3d-monospecific reagent, 83.6%–100.0% (N=72); antibody identification, 88.7%–99.2% (N=123); and ABO Ab titration, 84.6%–100.0% (N=73). The number of participants for the EQA for TMP in 2017 was much higher than that in 2016. Except for the case of ABO subtyping, excellent survey results for the 2017 EQA for TMP were obtained, compared to those in 2016. Thus, the EQA for TMP in 2017 should be helpful for improving the quality of the participating laboratories.
Coombs Test ; Korea* ; Laboratory Proficiency Testing ; Mass Screening ; Quality Improvement ; Thymidine Monophosphate ; Transfusion Medicine*

Post-traumatic stress disorder (PTSD) is a trauma-induced psychiatric disorder characterized by impaired fear extermination, hyperarousal, and anxiety that may involve the release of monoamines in the fear circuit. The reported pharmacological properties of tetramethylpyrazine (TMP) include anti-cancer, anti-diabetic, anti-atherosclerotic, and neuropsychiatric activities. However, the anxiolytic-like effects of TMP and its mechanism of action in PTSD are unclear. This study measured several anxiety-related behavioral responses to examine the effects of TMP on symptoms of anxiety in rats after single prolonged stress (SPS) exposure by reversing the serotonin (5-HT) and hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Rats were given TMP (10, 20, or 40 mg/kg, i.p.) for 14 days after SPS exposure. Administration of TMP significantly reduced grooming behavior, increased the time spent and number of visits to the open arm in the elevated plus maze test, and significantly increased the number of central zone crossings in the open field test. TMP administration significantly reduced the freezing response to contextual fear conditioning and significantly restored the neurochemical abnormalities and the SPS-induced decrease in 5-HT tissue levels in the prefrontal cortex and hippocampus. The increased 5-HT concentration during TMP treatment might be partially attribute to the tryptophan and 5-hydroxyindoleacetic acid mRNA level expression in the hippocampus of rats with PTSD. These findings support a role for reducing the altered serotonergic transmission in rats with PTSD. TMP simultaneously attenuated the HPA axis dysfunction. Therefore, TMP may be useful for developing an agent for treating psychiatric disorders, such those observed in patients with PTSD.
Animals ; Anxiety ; Arm ; Freezing ; Grooming ; Hippocampus ; Humans ; Models, Animal* ; Prefrontal Cortex ; Rats* ; RNA, Messenger ; Serotonin ; Stress Disorders, Post-Traumatic* ; Thymidine Monophosphate ; Tryptophan

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate how fibrinogen-based collagen fleece (Tachocomb®) graft myringoplasty (FCGM), performed under microscopic guidance, improves both hearing and tympanic membrane tissue repair in patients with traumatic tympanic membrane perforation (TMP). SUBJECTS AND METHODS: Between August 2009 and March 2015, a total of 52 patients with traumatic TMP visited the department of otorhinolaryngology at a secondary medical center. Twenty-nine of these underwent FCGM under microscopic guidance in our outpatient clinic. For each patient, we recorded the location and size of the perforation, the time elapsed from the onset of TMP until the myringoplasty, and the hearing level both before and after myringoplasty. RESULTS: The TMP closed completely in all cases (29 of 29 patients). After myringoplasty, the postoperative air-bone gap (ABG) differed significantly from the preoperative ABG. Three of the 29 patients (10.3%) experienced complications. Specifically, 2 presented with otorrhea after FCGM, but conservative management led to improvement without recurrence of perforation. One patient showed delayed facial palsy 1 week after the procedure. The condition of this patient also improved and the palsy was not permanent. CONCLUSIONS: FCGM may be an effective treatment option in case of traumatic TMP. The procedure requires no hospitalization, and can be used to avoid traditional tympanoplasty.
Ambulatory Care Facilities ; Collagen* ; Facial Paralysis ; Hearing ; Hearing Loss, Conductive ; Hospitalization ; Humans ; Myringoplasty* ; Otolaryngology ; Paralysis ; Recurrence ; Thymidine Monophosphate ; Transplants* ; Tympanic Membrane Perforation* ; Tympanic Membrane* ; Tympanoplasty

BACKGROUND AND OBJECTIVES: Aspiration thrombectomy (AT) during primary percutaneous coronary intervention (PCI) is an effective adjunctive therapy for ST-segment elevation myocardial infarction (STEMI). An elevated neutrophil count in STEMI is associated with microvascular dysfunction and adverse outcomes. We evaluated whether AT can improve microvascular dysfunction in patients with STEMI and an elevated neutrophil count. SUBJECTS AND METHODS: Seventy patients with STEMI undergoing primary PCI from August 2007 to February 2009 in our institution were classified by tertiles of neutrophil count on admission (<5,300/mm3, 5,300-7,600/mm3, and >7,600/mm3). The angiographic outcome was post-procedural thrombolysis in myocardial infarction (TIMI) flow grade. Microvascular dysfunction was assessed by TIMI myocardial perfusion (TMP) grade and ST-segment resolution on electrocardiography 90 minutes after PCI. The clinical outcome was major adverse cardiac event (MACE), defined as cardiac death, re-infarction, and target lesion revascularization at 9 months. RESULTS: There were no significant differences in the clinical characteristics and pre- and post-procedural TIMI flow grades between the neutrophil tertiles. As the neutrophil count increased, a lower tendency toward TMP grade 3 (83% vs. 52% vs. 54%, p=0.06) and more persistent residual ST-segment elevation (>4 mm: 13% vs. 26% vs. 58%, p=0.005) was observed. The 9-month MACE rate was similar between the groups. On subgroup analysis of AT patients (n=52) classified by neutrophil tertiles, the same tendency toward less frequent TMP grade 3 (77% vs. 56% vs. 47%, p=0.06) and persistent residual ST-segment elevation (>4 mm: 12% vs. 28% vs. 53%, p=0.05) was observed as neutrophil count increased. CONCLUSION: A higher neutrophil count at presentation in STEMI is associated with more severe microvascular dysfunction after primary PCI, which is not improved with AT.
Death ; Electrocardiography ; Humans ; Myocardial Infarction ; Neutrophils ; Percutaneous Coronary Intervention ; Perfusion ; Thrombectomy ; Thymidine Monophosphate

BACKGROUND AND OBJECTIVES: Aspiration thrombectomy (AT) during primary percutaneous coronary intervention (PCI) is an effective adjunctive therapy for ST-segment elevation myocardial infarction (STEMI). An elevated neutrophil count in STEMI is associated with microvascular dysfunction and adverse outcomes. We evaluated whether AT can improve microvascular dysfunction in patients with STEMI and an elevated neutrophil count. SUBJECTS AND METHODS: Seventy patients with STEMI undergoing primary PCI from August 2007 to February 2009 in our institution were classified by tertiles of neutrophil count on admission (<5,300/mm3, 5,300-7,600/mm3, and >7,600/mm3). The angiographic outcome was post-procedural thrombolysis in myocardial infarction (TIMI) flow grade. Microvascular dysfunction was assessed by TIMI myocardial perfusion (TMP) grade and ST-segment resolution on electrocardiography 90 minutes after PCI. The clinical outcome was major adverse cardiac event (MACE), defined as cardiac death, re-infarction, and target lesion revascularization at 9 months. RESULTS: There were no significant differences in the clinical characteristics and pre- and post-procedural TIMI flow grades between the neutrophil tertiles. As the neutrophil count increased, a lower tendency toward TMP grade 3 (83% vs. 52% vs. 54%, p=0.06) and more persistent residual ST-segment elevation (>4 mm: 13% vs. 26% vs. 58%, p=0.005) was observed. The 9-month MACE rate was similar between the groups. On subgroup analysis of AT patients (n=52) classified by neutrophil tertiles, the same tendency toward less frequent TMP grade 3 (77% vs. 56% vs. 47%, p=0.06) and persistent residual ST-segment elevation (>4 mm: 12% vs. 28% vs. 53%, p=0.05) was observed as neutrophil count increased. CONCLUSION: A higher neutrophil count at presentation in STEMI is associated with more severe microvascular dysfunction after primary PCI, which is not improved with AT.
Death ; Electrocardiography ; Humans ; Myocardial Infarction ; Neutrophils ; Percutaneous Coronary Intervention ; Perfusion ; Thrombectomy ; Thymidine Monophosphate

BACKGROUND: Continuous venovenous hemodiafiltration (CVVHDF) is advantageous in ARF patients with the unstable emodynamics and multiorgan failure. However, use of anticoagulation is sometimes hampered by their concurrent bleeding tendency. We performed the retrospective analysis to investigate the factors that could influence on the filter life. METHODS: The patients on CVVHDF without anticoagulation who required exchange of filter 8 times or more due to clotting were included. We measured filter life, clotting time, hemoglobin, platelet count, blood flow rate, dialysate flow rate, replacement fluid flow rate and blood pressure just before the initiation of every filter. We also measured mechanical pressures relevant to the filter, such as access pressures, filter pressure, return pressure and transmembrane pressure (TMP) within the last 6 hours before termination of every filter. RESULTS: Twenty-three patients (age 57+/-16, M: F=19: 4) showed the median filter life of 9 hours 20 minutes. The filter life was not influenced by the included variables. TMP significantly increased every hour during the last 6 hours before the end of filter life (p<0.01). When TMP was greater than 120 mmHg, TMP significantly increased every hour thereafter and CVVHDF was terminated within 4 hours. CONCLUSION: This study suggested that the possibility of filter clotting should be suspected when TMP is greater than 120 mmHg in the setting of CVVHDF without anticoagulation.
Blood Pressure ; Hemodiafiltration* ; Hemorrhage ; Humans ; Platelet Count ; Retrospective Studies ; Thymidine Monophosphate

BACKGROUND AND OBJECTIVES: Elevated hs-CRP (high sensitivity C-reactive protein) is well known as a biomarker reflecting the inflammatory process that might evoke the potential for microembolization of an atheromatous plaque, and imparts a poor prognosis in patients with coronary artery disease. We designed this study to evaluate whether the preprocedural hs-CRP level was associated with procedure-related myocardial injury following coronary stenting. SUBJECTS AND METHODS: We obtained the plasma hs-CRP level from angina patient, who underwent coronary stenting, within 24 hours prior to the procedure, and divided the patients into either the normal CRP (hs-CRP <3 mg/L) or elevated CRP groups (hs-CRP > or =3 mg/L). We defined the reduction of TMP (TIMI myocardial perfusion) grade as at least one decrease in the TMP grade following coronary stenting compared with the pre-procedural TMP. We also evaluate the procedure-related myocardial damage by measuring CK-MB leakage after stenting. RESULTS: We enrolled 279 lesions in 226 patients, who were divided into two groups: the normal CRP group (n=137, 1.28+/-0.71 mg/L) and the elevated CRP group (n=89, 6.89+/-4.23 mg/L). A reduction in the TMP grade was significantly more prevalent in the elevated CRP (20 lesions, 17.4%) compared to the normal CRP group (6 lesions, 3.7%, p=0.001). An elevated CRP level was related to an increased CK-MB leakage following stenting (elevated CRP group; 23 patients, 25.8%, normal CRP group; 21 patients, 15.3%, p=0.041). In a multivariable analysis, the only significant predictor of a reduction in the TMP grade following stenting was an elevated CRP level. CONCLUSION: Systemically detectable inflammatory activity, served by the plasma hs-CRP level, is associated with procedure-related microvascular injury, as assessed by a reduction in the TMP grade and CK-MB elevation following coronary stenting.
C-Reactive Protein ; Coronary Artery Disease ; Humans ; Microcirculation ; Plasma ; Prognosis ; Stents* ; Thymidine Monophosphate

BACKGROUND AND OBJECTIVES: Phasic coronary flow velocity patterns and microvascular integrities are known to be prognostic factors in acute myocardial infarction (AMI). The use of a distal protection device during primary percutaneous coronary intervention (PCI) may preserve the microvascular integrity of the myocardium by preventing distal embolization of thrombotic materials. This study assessed the effects of such a device on microvascular integrity preservation through Doppler studies of the coronary flow velocities in AMI patients treated with primary PCI. SUBJECTS AND METHODS: A total of fifty-eight consecutive patients (mean age 54+/-15, 46 males) with ST segment-elevated AMI, who had undergone primary PCI within 24 hours after onset, were enrolled in the study. The subjects were divided into two groups: 30 patients with the PurcuSurge GuardWire Temporary Occlusion and Aspiration System and 28 without. The TIMI flows and TMP grades (TIMI myocardial perfusion grade) were evaluated. The coronary flow velocities were measured after PCI with a Doppler wire at the baseline, and also after intracoronary adenosine (24-48 microgram) induced hyperemia. The coronary flow velocity reserve (CFR), diastolic deceleration time (DDT) and microvascular resistance index (MVRI) were calculated. RESULTS: Between the two groups, no significant differences were found in the angiographic characteristics and CFR. In patients with a distal protection device, however, the post-PCI TMP grades were more favorable (TMP 0/1: 13.3%, TMP 2: 23.3%, TMP 3: 63.4% vs. TMP 0/1: 35.7%, TMP 2: 35.7%, TMP 3: 28.6%, p=0.023), with TMP grade 3 being most common (63.4% vs. 28.6%, p=0.010). These patients also exhibited lower bMVRI and hMVRI levels (4.33+/-2.22 vs. 5.55+/-2.36 mmHg.m-1.sec (p=0.047) and 2.39+/-1.40 vs. 3.14+/-1.36 mmHg.cm-1. sec (p=0.045), respectively), and longer bDDT and hDDT (679+/-273 vs. 519+/-289 msec (p=0.035) and 761+/-256 vs. 618+/-272 msec (p=0.044), respectively). CONCLUSIONS: Distal protection with the PurcuSurge GuardWire system may effectively preserve the microvascular integrity of the myocardium during primary PCI in AMI patients.
Adenosine ; Deceleration ; Humans ; Hyperemia ; Myocardial Infarction* ; Myocardium ; Percutaneous Coronary Intervention ; Perfusion ; Stents* ; Thymidine Monophosphate

BACKGROUND AND OBJECTIVES: It remains to be defined how K[ATP] Channel Opener facilitates to induce ventricular arrhythmias. The purposes of this study are to assess the effects of K[ARP] Channel Opener, PCO400, on the action potential duration (APD) and APD restitution (APDR) kinetics, and their relationship with induction of ventricular tachycardia (VT)/fibrillation (VF), pro-fibrillatory effects. MATERALS AND METHODS: We recorded transmembrane potentials (TMPs) by microelectrode technique to explore the effects of PCO400 in ninetecn isolated perfused swine right ventricles. TMPs were recorded on the endoeardial side at the concentrations 0 micrometer, 1 micrometer, 2.5 micrometer, 5 micrometer, 10 micrometer, and washed-out period (1 hour). Ventricular refractory periods were measured while scanning djastole with premature ventricular beats during pacing at the cycle length of 600 ms at each concentration. The maximal slopes (Smax) of APDR were calculated with the data of S1S2 pacing and VF. RESULTS: PCO400 reduced APD90 (208+/-76 ms to 41+/-9 ms during S1, p<0.001, 111+/-32 ms to 54+/-28 ms during VF, p<0.001). While PCO400 tended to increase Smax of APDR at the concentration of 1 micrometer (0.6 to 0.7 by S1S2, 2.3 to 3.0 during VF), it reduced Smax at higher concentrations (-0.01 by S1-S2, p<0.05;-1.1 during VF, p<0.01). The increment of PCO400 concentration was associated with facilitated VT/VF induction (24.4% to 100%, p<0.001). Spontaneous VF induction rate was the highest at 1 micrometer (38.5%) which resulted in the highest Smax. CONCLUSION: PCO400 shows pro-fibrillatory effect by APD reduction and dynamic changes of Smax, Smax is closely related to spontancous induction of VT/VF, and APD90 shortening below 70 ms is critical for the maintenance of VT/VF.
Action Potentials* ; Arrhythmias, Cardiac ; Heart Ventricles* ; Kinetics* ; Membrane Potentials ; Microelectrodes ; Swine* ; Tachycardia, Ventricular ; Thymidine Monophosphate ; Ventricular Premature Complexes