Type 2 diabetic nephropathy (T2DN) progresses with an increasingly inflammatory milieu, wherein various immune cells are relevant. Herein, we investigated the levels of myeloid-derived suppressor cells (MDSCs) and their clinical implication in patients with T2DN. A total of 91 subjects (T2DN, n=80; healthy, n=11) were recruited and their PBMCs were used for flow cytometric analysis of polymorphonuclear (PMN-) and monocytic (M-) MDSCs, in addition to other immune cell subsets. The risk of renal progression was evaluated according to the quartiles of MDSC levels using the Cox model. The proportion of MDSCs in T2DN patients was higher than in healthy individuals (median, 6.7% vs. 2.5%). PMN-MDSCs accounted for 96% of MDSCs, and 78% of PMN-MDSCs expressed Lox-1. The expansion of PMN-MDSCs was not related to the stage of T2DN or other kidney disease parameters such as glomerular filtration rate and proteinuria. The production of ROS in PMN-MDSCs of patients was higher than in neutrophils of patients or in immune cells of healthy individuals, and this production was augmented under hyperglycemic conditions. The 4th quartile group of PMN-MDSCs had a higher risk of renal progression than the 1st quartile group, irrespective of adjusting for multiple clinical and laboratory variables. In conclusion, PMN-MDSCs are expanded in patients with T2DN, and may represent as an immunological biomarker of renal progression.

This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 +/- 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m2) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.
Adult ; Aged ; Aged, 80 and over ; Cardiovascular Diseases/diagnosis/*mortality ; Comorbidity ; Coronary Angiography/*statistics & numerical data ; Coronary Stenosis/mortality/radiography ; Female ; Humans ; Incidence ; Kidney Diseases/*diagnosis/*mortality ; Kidney Function Tests/*statistics & numerical data ; Male ; Middle Aged ; Prognosis ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Assessment ; Sensitivity and Specificity ; Survival Rate ; Tomography, X-Ray Computed/*statistics & numerical data

The efficacy of tandem high-dose chemotherapy and autologous stem cell rescue (HDCT/ASCR) was investigated in patients with high-risk neuroblastoma. Patients over 1 yr of age who were newly diagnosed with stage 4 neuroblastoma from January 2000 to December 2005 were enrolled in The Korean Society of Pediatric Hematology-Oncology registry. All patients who were assigned to receive HDCT/ASCR at diagnosis were retrospectively analyzed to investigate the efficacy of single or tandem HDCT/ASCR. Seventy and 71 patients were assigned to receive single or tandem HDCT/ASCR at diagnosis. Fifty-seven and 59 patients in the single or tandem HDCT group underwent single or tandem HDCT/ASCR as scheduled. Twenty-four and 38 patients in the single or tandem HDCT group remained event free with a median follow-up of 56 (24-88) months. When the survival rate was analyzed according to intent-to-treat at diagnosis, the probability of the 5-yr event-free survival+/-95% confidence intervals was higher in the tandem HDCT group than in the single HDCT group (51.2+/-12.4% vs. 31.3+/-11.5%, P=0.030). The results of the present study demonstrate that the tandem HDCT/ASCR strategy is significantly better than the single HDCT/ASCR strategy for improved survival in the treatment of high-risk neuroblastoma patients.
Adolescent ; Child ; Child, Preschool ; Combined Modality Therapy/mortality ; Drug Therapy/*mortality ; Female ; Humans ; Infant ; Korea/epidemiology ; Longitudinal Studies ; Male ; Neuroblastoma/*mortality/*therapy ; Prevalence ; Risk Assessment/methods ; Risk Factors ; Stem Cell Transplantation/*mortality ; Survival Analysis ; Survival Rate ; Treatment Outcome

PURPOSE: We wished to compare the ability of ultrasonography and radiography performed on the same day to detect rib fractures in minor chest injuries. MATERIALS AND METHODS: Two hundred and fifteen patients with minor chest injuries were selected. Radiography and ultrasonography were performed on the same day with these patients. Chest wall pain was the only presenting symptom. Two radiologists performed ultrasonography. Fractures were identified by a disruption of the anterior margin of the rib and costal cartilage. The incidence and location of fractures and complications revealed by radiography and ultrasonography were compared. RESULTS: Radiographs revealed the presence of 70 rib fractures in 50 (23%) of 215 patients and ultrasonography revealed the presence of 203 rib fractures in 133 (62%) of 215 patients. Ultrasonography uniquely identified 133 rib fractures in 83 patients. Ultrasonography identified a 2.9 fold increase in the number of fractures in a 2.6 fold number of subjects as compared to radiography. Of the 203 sonographically detected fractures, 201 were located in the rib, one was located at the costochondral junction, and one in the costal cartilage. There were no complications seen by either radiography or ultrasonography. CONCLUSION: Ultrasonography reveals more fractures than those that may be overlooked on radiography for minor chest injuries.
Cartilage ; Humans ; Incidence ; Radiography* ; Rib Fractures* ; Ribs* ; Thoracic Injuries* ; Thoracic Wall ; Thorax* ; Ultrasonography*

Hepatitis A is one of the most common infectious diseases. It is a self-limiting disease affecting the liver. Although extrahepatic manifestations are not common, a few cases associated with renal diseases have been reported. In those cases, patients presented with acute tubular necrosis, acute interstitial nephritis, IgA nephropathy, mesangioproliferative glomerulonephritis, etc. We here report a case of interstitial nephritis and IgA nephropathy associated with acute hepatitis A. A previously healthy 31-year old woman was admitted with an acute hepatitis A, which was confirmed by IgM anti-hepatitis A antibody. Acute renal failure was developed and hemodialysis was urgently required. The patient had acute interstitial nephritis and IgA nephropathy diagnosed by kidney biopsy. Liver and kidney functions gradually recovered their normal conditions.
Acute Kidney Injury ; Adult ; Biopsy ; Communicable Diseases ; Female ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Hepatitis A* ; Hepatitis* ; Humans ; Immunoglobulin A* ; Immunoglobulin M ; Kidney ; Liver ; Necrosis ; Nephritis, Interstitial* ; Renal Dialysis

PURPOSE: To evaluate the diagnostic capabilities of the low-field (0.2T) magnetic resonance (MR) system in the detection of the superior labrum anterior to posterior (SLAP) lesion. MATERIALS AND METHODS: One hundred fifty patients underwent magnetic resonance imaging of the shoulder over a 7-month period. Forty-six patients underwent arthroscopic surgery, and the surgical results were correlated with the findings of the MR imaging. Arthroscopic procedures were performed within a mean of 8 days after MR imaging. MR imaging of the shoulder was conducted as follows: shoulder coil; T1-weighted spin echo, coronal-oblique images; T2-weighted gradient echo, coronal-oblique and axial images; and T2-weighted spin echo, coronal-oblique and sagittal-oblique images. Prospectively, one radiologist interpreted the MR images. RESULTS: The results of surgery were as follows: SLAP II in 26 shoulders, SLAP III in 1 shoulder, SLAP IV in 1 shoulder, normal labrum in 6 shoulders. For SLAP lesions with a higher grade than type 2, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the low-field MRI were 85.7%, 55.5%, 75%, 71%, and 74%, respectively. CONCLUSION: There was relatively good agreement for the comparison of the MR results obtained using a low-field MR system with the surgical findings for identifying SLAP lesions.
Arthroscopy ; Humans ; Magnetic Resonance Imaging ; Prospective Studies ; Sensitivity and Specificity ; Shoulder

Haemorrhagic fever with renal syndrome (HFRS) caused by Hantaan viruses has been one of the principal acute febrile disease in Korea. To analysis the sero-epidemiological patterns of HFRS, 4,177 patient sera of acute febrile illness submitted for serological assay to National Institute of Health from Community Health Centers, Institutes of Health and Environment and hospitals from 1996 to 2005 were examined for antibodies against Hantaan virus by indirect immunofluorescent assay (IFA). Serum samples with greater than 1:32 antibody titer were considered positive. The results were analyzed seroepidemiologically by annual, sexual, seasonal, age and regional distribution of HFRS patients. Out of 4,177 serum samples tested, 1,415 samples (33.9%) were positive to Hantaan virus. The ratio of males (48.2%, 682/1,415) to females (38.2%, 541/1,415) was 1.3:1. Seasonal incidence showed that 69.5% (985/1,415) of cases occurred from October to December, resulting with higher prevalence in November (41.3%, 584/1,415). Regionally, seropositive rates of samples collected in Gyenggi, Gangwon and Chungbuk were 39.9% (564/1,415), 19.3% (274/1,415) and 8.5% (120/1,1415), respectively. Age distributions of seropositive of HFRS were detected from 20 to 79 years (78%).
Academies and Institutes ; Age Distribution ; Antibodies ; Chungcheongbuk-do ; Community Health Centers ; Female ; Fever* ; Gangwon-do ; Hantaan virus ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Incidence ; Korea* ; Male ; Prevalence ; Seasons

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is one of the most important armamentarium against various hematologic malignancies or some solid tumors. We investigated the number of patients who might need transplants and compared with that of actual transplants to conceptualize current status and circumstances of HSCTs in Korean children. METHODS: Questionnaires were sent to Korean Society of Hematopoietic Stem Cell Transplantation (KSHSCT) members who were taking care of children with malignancies or hematologic diseases. Almost all of the newly diagnosed patients between Jan, 1st and Dec, 31st, 2003 were enrolled in the study. RESULTS: Seven hundred forty eight children (male to female ratio = 1.4:1) were enrolled. The median age was 6.1 years old (8 days~28.8 years old). Malignant diseases consisted of 695 cases (92.9%), and among them almost half were hematologic malignancies. The participating members speculated that HSCTs should be indicated in 285 children (38.1%) which included 209 allogeneic, and 76 autologous transplants. In reality, however, allogeneic HSCTs were performed only in 140 children (67.0%) with the median interval of 5.9 month, and autologous transplants in 44 children (57.9%) with 8.3 month. In autologous setting, all the patients received peripheral blood stem cells (PBSCs), whereas bone marrow (61%), cord blood (34%), and PBSC (5%) were used in allogeneic HSCTs. Donor types were as follows: unrelated donor (37%), cord blood (34%), sibling donor (25%), and family (4%). The reasons for not performing HSCTs were unfavorable disease status or death, no availability of suitable donor, economical situation, and refusal by parental preferences. Under the strict insurance regulations, many transplants were not covered by insurance. More autologous transplants were performed without insurance coverage than allogeneic HSCTs (P=0.013). Those cases were advanced cases and HLA mismatch transplants for allogeneic setting, and relatively rare diseases still awaiting favorable results of transplants for autologous setting. CONCLUSION: HSCTs are essential part of treatment strategies for children with various diseases. Unfortunately, however, a third of patients who were in need of transplants did not receive HSCTs due to various reasons. It is necessary to expand unrelated donor pool or cord blood banks for the cases lacking HLA-identical sibling donors. Also medical insurances should cover HSCTs for rare diseases as well as for less favorable but novel situations where there are no suitable alternatives.
Autografts ; Bone Marrow ; Child* ; Disulfiram ; Female ; Fetal Blood ; Hematologic Diseases ; Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Insurance ; Insurance Coverage ; Parents ; Rare Diseases ; Siblings ; Social Control, Formal ; Stem Cells ; Tissue Donors ; Unrelated Donors ; Surveys and Questionnaires

OBJECTIVE: In this study, the exposure levels of polycyclic aromatic hydrocarbons (PAHs) and urinary 1-hydroxypyrene(1-OHP) were surveyed among the workers using coal tar paint. METHOD: The study subjects for the exposed group were 107 male coal tar workers in 10 factories, and for the comparison group were 201 male clerk workers who had never been exposed to coal tar paint. Ambient PAHs, and pre-shift and end-shift urinary 1-OHP were sample and 16 PAHs were analysed. Smoking history was recorded during the survey day. RESULTS: The geometric mean of ambient concentration of total PAHs was 120.17 microgram/m3. Naphthalene had the highest level among the 16 PAHs. The pre-shift 1-OHP in the exposed group (8.89 micro mol/mol creatinine) was significantly higher than that in the control group (0.29 micro mol/mol creatinine). The end-shift 1-OHP in the exposed group (19.02 micro mol/mol creatinine) was significantly higher than that in the pre-shift (8.89 micro mol/mol creatinine) (Ed- confirm). 1-OHP of smokers was significantly higher than that of non-smokers in both groups. The difference between pre-shift and end-shift 1-OHP in smokers (12.40 micro mol/mol creatinine) was twice as high as that in non-smokers (6.06 micro mol/mol creatinine). The difference of 1-OHP between smokers and nonsmokers was 7.59 micro mol/mol creatinine in pre-shift and 13.96 micro mol/mol creatinine in end-shift. Thus, the effect of smoking and exposure to PAHs on 1-OHP may not be additive. In regression analysis for 1-OHP, the significant independent variables were pre-shift 1-OHP and PAHs. The direction of these variables was positive. When the analysis was performed in workers exposed to higher PAHs, smoking was significant independent variable. CONCLUSION: The above results suggest that not only ambient PAHs but also smoking, one of the most important non-occupational PAHs source, influenced the level of 1-OHP. Moreover, the effect of smoking to 1-OHP changed according to the exposure level of PAHs.
Coal Tar* ; Coal* ; Creatinine ; Humans ; Male ; Paint* ; Polycyclic Hydrocarbons, Aromatic* ; Smoke ; Smoking

Hantaan viruses cause haemorrhagic fever with renal syndrome (HFRS), resulting in severe morbidity and mortality in humans. The genome of Hantaan virus is composed of three segmented and single stranded negative sense RNA genome. In this study, we expressed nucleocapsid (N) proteins of Hantaan 76-118, Seoul 80-39 and Hantaan virus isolated in Korea (01-23) using E. coli system. These N proteins were fused with a thioredoxin protein for secretion of the expressed protein. The antigenicity of each expressed N proteins was examined in Western blot with sera from HFRS patients and normal controls. The expressed N proteins did not show any cross-reactivity with sera obtained from patients with leptospirosis and tsutsugamushi disease. These results suggest that our recombinant N proteins can be used for the development of diagnostic system to distinguish between HFRS and leptospirosis or tsutsugamushi.
Blotting, Western ; Fever ; Genome ; Hantaan virus ; Hantavirus* ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Korea ; Leptospirosis ; Mortality ; Nucleocapsid ; RNA ; Scrub Typhus ; Seoul ; Thioredoxins