Background/Aims: While switching strategies of P2Y12 receptor inhibitors (RIs) have sometimes been used in acute myocardial infarction (AMI) patients, the current status of in-hospital P2Y12RI switching remains unknown. Methods: Overall, 8,476 AMI patients who underwent successful revascularization from Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) were divided according to in-hospital P2Y12RI strategies, and net adverse cardiovascular events (NACEs), defined as a composite of cardiac death, non-fatal myocardial infarction (MI), stroke, or thrombolysis in myocardial infarction (TIMI) major bleeding during hospitalization were compared. Results: Patients with in-hospital P2Y12RI switching accounted for 16.5%, of which 867 patients were switched from clopidogrel to potent P2Y12RI (C-P) and 532 patients from potent P2Y12RI to clopidogrel (P-C). There were no differences in NACEs among the unchanged clopidogrel, the unchanged potent P2Y12RIs, and the P2Y12RI switching groups. However, compared to the unchanged clopidogrel group, the C-P group had a higher incidence of non-fatal MI, and the P-C group had a higher incidence of TIMI major bleeding. In clinical events of in-hospital P2Y12RI switching, 90.9% of non-fatal MI occurred during pre-switching clopidogrel administration, 60.7% of TIMI major bleeding was related to pre-switching P2Y12RIs, and 71.4% of TIMI major bleeding was related to potent P2Y12RIs. Only 21.6% of the P2Y12RI switching group switched to P2Y12RIs after a loading dose (LD); however, there were no differences in clinical events between patients with and without LD. Conclusions In-hospital P2Y12RI switching occurred occasionally, but had relatively similar clinical outcomes compared to unchanged P2Y12RIs in Korean AMI patients. Non-fatal MI and bleeding appeared to be mainly related to pre-switching P2Y12RIs.

Nephrogenic systemic fibrosis (NSF) is a progressive systemic fibrosing disease that may occur after gadolinium contrast exposure. It can lead to severe complications and even death.NSF is highly prevalent among patients with advanced chronic kidney disease (CKD). In this report, however, we describe the case of a patient with NSF that occurred during early CKD. A 65-year-old man with stage 3a CKD was transferred to our hospital because of lower extremity edema. The medical history revealed that he was exposed to gadolinium 185 days earlier, and the result of his tibial skin biopsy was consistent with NSF. The patient underwent a combined therapy with ultraviolet-A1 phototherapy and methotrexate and steroid therapy for 6 months. The combined therapy stopped the systemic progression of NSF.

PURPOSE: The optimal indications for omitting adjuvant radiation therapy (RT) after breast-conserving surgery are still controversial in ductal carcinoma in situ (DCIS) of the breast. The purpose of this study was to validate the role of postoperative RT in DCIS patients aged ≤50 years and with tumor margin widths of <1 cm, both of which have been proven to be high-risk features for recurrence in cohorts not receiving RT. METHODS: Using two multicenter retrospective studies on DCIS, a pooled analysis was performed among patients aged ≤50 years and with margin widths < 1 cm. All patients underwent breast-conserving surgery. Two hundred thirty-two patients received postoperative RT, while 54 did not. The median follow-up period was 77 months (range, 2–190 months) and 70 months (range, 5–166 months) in the patients who received RT and those who did not, respectively. RESULTS: The patients who received RT had larger tumors (p < 0.001), higher nuclear grade (p < 0.001), closer margin width (p < 0.001), and negative estrogen receptor expression (p=0.010) compared with those who did not receive RT. During the follow-up period, there were 17 ipsilateral breast tumor recurrences (IBTRs) as follows: invasive carcinoma in 10 patients and DCIS in seven. In the univariate analysis, the treatment with RT and human epidermal growth factor receptor 2 (HER2) status were significant risk factors for IBTR. The 7-year IBTR rates with and without postoperative RT were 3.6% and 13.1%, respectively (p=0.008). HER2-positive tumors had a higher IBTR rate than the HER2-negative tumors (7-year rate, 13.6% vs. 3.9%; p=0.003). CONCLUSION: Postoperative RT following breast-conserving surgery significantly reduced the 7-year IBTR rate in the DCIS patients aged ≤50 years and with margin widths < 1 cm. HER2 positivity was associated with increased IBTR in these patients.
Age Factors ; Breast ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Cohort Studies ; Estrogens ; Follow-Up Studies ; Humans ; Mastectomy, Segmental* ; Radiation Oncology* ; Radiotherapy ; Receptor, Epidermal Growth Factor ; Recurrence ; Retrospective Studies ; Risk Factors

Prolonged hypokalemia from chronic laxative abuse is recognized as the cause of chronic tubulointerstitial disease, known as "hypokalemic nephropathy," but it is not clear whether it contributes to acute kidney injury (AKI). A 42-year-old woman with a history of chronic kidney disease as a result of chronic laxative abuse from a purging type of anorexia nervosa (AN-P), developed an anuric AKI requiring hemodialysis and a mild AKI 2 months later. Both episodes of AKI involved severe to moderate hypokalemia (1.2 and 2.7 mmol/L, respectively), volume depletion, and mild rhabdomyolysis. The histologic findings of the first AKI revealed the remnants of acute tubular necrosis with advanced chronic tubulointerstitial nephritis and ischemic glomerular injury. Along with these observations, the intertwined relationship among precipitants of recurrent AKI in AN-P is discussed, and then we postulate a contributory role of hypokalemia involved in the pathophysiology of the renal ischemia-induced AKI.
Acute Kidney Injury* ; Adult ; Anorexia Nervosa ; Female ; Humans ; Hypokalemia* ; Necrosis ; Nephritis, Interstitial ; Renal Dialysis ; Renal Insufficiency, Chronic ; Rhabdomyolysis

JL1, a specific epitope on CD43, is a potential biomarker for the diagnosis of acute leukemia. Although qualitative assays for detecting leukemia-specific CD43 exist, there is a need to develop quantitative assays for the same. Here, we developed two novel monoclonal antibodies (mAbs), 2C8 and 8E10, recognizing different epitopes on CD43. These clones are capable of pairing with YG5, another mAb against JL1 epitope, because they were selectively obtained using sandwich ELISA. Antigens recognized by 2C8 and 8E10 were confirmed as CD43 by western blotting using the CD43-hFC recombinant protein. When expression on various leukemic cell lines was investigated, 2C8 and 8E10 displayed a disparity in the distribution of the epitope. Enzyme assays revealed that these mAbs recognized a sialic acid-dependent epitope on CD43. Using normal thymus and lymph node paraffin-embedded tissues, we confirmed a difference in the epitopes recognized by the two mAbs that was predicted based on the maturity of the cells in the tissue. In summary, we developed and characterized two mAbs, 2C8 and 8E10, which can be used with YG5 in a sandwich ELISA for detecting leukemia-specific CD43.
Antibodies, Monoclonal ; Blotting, Western ; Cell Line ; Clone Cells ; Diagnosis ; Enzyme Assays ; Enzyme-Linked Immunosorbent Assay ; Epitopes* ; Leukemia ; Lymph Nodes ; Thymus Gland

We investigated a novel process for production of ethanol from glycerol using the yeast Pachysolen tannophilus. After optimization of the fermentation medium, repeated-batch flask culture was performed over a period of 378 hr using yeast cells immobilized on Celite. Our results indicated that the use of Celite for immobilization of P. tannophilus was a practical approach for ethanol production from glycerol, and should be suitable for industrial ethanol production.
Diatomaceous Earth* ; Ethanol* ; Fermentation ; Glycerol* ; Immobilization ; Yeasts*

We evaluated a more practical and cost-effective immobilization carriers for ethanol production using the yeast Saccharomyces cerevisiae. Three candidate materials-rice hull, rice straw, and sawdust-were tested for their cell-adsorption capacity and operational durability. Derivatizations of rice hull, rice straw, and sawdust with the optimal concentration of 0.5 M of 2-(diethylamino)ethyl chloride hydrochloride (DEAE . HCl) resulted in > 95% adsorption of the initial yeast cells at 2 hr for DEAE-rice hull and DEAE-sawdust and in only approximately 80% adsorption for DEAE-rice straw. In addition, DEAE-sawdust was found to be a more practical carrier for immobilizing yeast cells in terms of operational durability in shaking flask cultures with two different speeds of 60 and 150 rpm. Furthermore, the biosorption isotherms of DEAE-rice hull, -rice straw, and -sawdust for yeast cells revealed that the Qmax of DEAE-sawdust (82.6 mg/g) was greater than that of DEAE-rice hull and DEAE-rice straw. During the 404-hr of continuous column reactor operation using yeast cells immobilized on DEAE-sawdust, no serious detachment of the yeast cells from the DEAE-sawdust was recorded. Ethanol yield of approximately 3.04 g/L was produced steadily, and glucose was completely converted to ethanol at a yield of 0.375 g-ethanol/g-glucose (73.4% of the theoretical value). Thus, sawdust is a promising practical immobilization carrier for ethanol production, with significance in the production of bioethanol as a biofuel.
Adsorption ; Biofuels ; Ethanol* ; Glucose ; Immobilization ; Saccharomyces cerevisiae* ; Yeasts

BACKGROUND/AIMS: Elderly patients with advanced gastric cancer (AGC) have generally been excluded from clinical trials, and there are few data available on the treatment of these patients. The efficacy of palliative S-1 monotherapy as a first-line treatment regimen for elderly patients has not been well elucidated. METHODS: For this study, 25 AGC patients were enrolled between January 1, 2007 and March 31, 2009; 4 cases were recurrent AGC and 21 cases were metastatic AGC at the time of diagnosis. These patients received S-1 therapy at a dose of 40 mg/m2 twice daily for 14 days every 3 weeks. All of the patients were older than 70 years. RESULTS: The median follow-up duration, the median progression-free survival, and the overall survival time were 8.7 months (range, 4.9 to 12.5 months), 4.9 months (range, 3.5 to 6.3 months), and 10.8 months (range, 6.6 to 15.0 months), respectively. Grade 3/4 nonhematologic toxicities were rare. Grade 3/4 neutropenia was noted in two patients. The partial response rate was 21.7% and stable disease was observed in 34.8% of the patients. Two patients (8%) died due to chemotherapy-associated toxicity during treatment (septic shock/intracranial hemorrhage). CONCLUSIONS: Oral S-1 chemotherapy seems to be effective as a first-line treatment regimen for elderly patients with metastatic or recurrent AGC. However, elderly patients receiving S-1 treatment should undergo continuous toxicity monitoring, since they are highly susceptible to adverse effects.
Aged ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Neutropenia ; Stomach Neoplasms

BACKGROUND: We wanted to evaluate whether a minimal extrathyroid extension (METE) is associated with the clinicopathological parameters that are indicative of a poor prognosis, including lymph node metastasis, distant metastasis at the time of the initial diagnosis and tumor recurrence, in patients with papillary thyroid carcinoma (PTC), and especially in the patients with papillary thyroid microcarcinoma (PTMC). METHODS: We retrospectively evaluated the medical records of patients with PTC and who had undergone total thyroidectomy with/without subsequent 131I remnant ablation at the Korea Cancer Center Hospital from January 1998 through December 2005. A total of 557 patients with PTC were enrolled in the study. We excluded 13 patients with an unknown status of extension and 29 patients with massive ETE. RESULTS: Of the 515 patients, 401 were found to have a METE. We analyzed the 464 patients who were without distant metastasis at the time of the initial diagnosis and who had a follow-up duration of more than 6 months. METE was not significantly associated with tumor recurrence during the follow-up period (median follow-up period: 122 months, range: 6-142 months): 8% vs. 15% of the patients with and without METE had tumor recurrence, respectively (P = 0.069 by the log-rank test). We analyzed the effect of tumor size in the patients with METE. Size was not significantly associated with tumor recurrence (P = 0.374 by the log-rank test). CONCLUSION: These findings suggest that METE might not be a prognostic factor to predict tumor recurrence in patients with PTC, including PTMC.
Carcinoma ; Carcinoma, Papillary ; Factor IX ; Follow-Up Studies ; Humans ; Korea ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

OBJECTIVE: To investigate the effect of driving-simulator based training for the persons with brain injury. METHOD: Twenty-seven brain injury patients and 19 healthy volunteers were included in this study. Driving simulator program was composed of an aptitude test (which have 4 items) and simulated road driving. The brain injury patients had 4 sessions of driving simulator training with assessment performed during the first and the last session. Healthy volunteers underwent only one driving simulator session for assessment. To evaluate subjective satisfaction in terms of training effect and the sense for the real, a survey was administered after the training. RESULTS: In brain injury patients, there were significant improvements in both aptitude test and simulated road driving test after training (p <0.01). There were no significant differences between the scores of patients taken at the last session and the scores of healthy volunteers, while the scores of patients taken at the first session were significantly lower than those of healthy volunteers. The patients group reported positively in terms of training effect (81.5%) and the sense for the real (62.9%). CONCLUSION: A driving-simulator based training was effective for brain injury patients to regain driving skill.
Aptitude Tests ; Brain ; Brain Injuries ; Humans