AI-Driven Segmentation and Automated Analysis of the Whole Sagittal Spine from X-ray Images for Spinopelvic Parameter Evaluation.

Spinal-pelvic parameters are utilized in orthopedics for assessing patients' curvature and body alignment in diagnosing, treating, and planning surgeries for spinal and pelvic disorders. Segmenting and autodetecting the whole spine from lateral radiographs is challenging. Recent efforts have employed deep learning techniques to automate the segmentation and analysis of whole-spine lateral radiographs. This study aims to develop an artificial intelligence (AI)-based deep learning approach for the automated segmentation, alignment, and measurement of spinal-pelvic parameters through whole-spine lateral radiographs. We conducted the study on 932 annotated images from various spinal pathologies. Using a deep learning (DL) model, anatomical landmarks of the cervical, thoracic, lumbar vertebrae, sacrum, and femoral head were automatically distinguished. The algorithm was designed to measure 13 radiographic alignment and spinal-pelvic parameters from the whole-spine lateral radiographs. Training data comprised 748 digital radiographic (DR) X-ray images, while 90 X-ray images were used for validation. Another set of 90 X-ray images served as the test set. Inter-rater reliability between orthopedic spine specialists, orthopedic residents, and the DL model was evaluated using the intraclass correlation coefficient (ICC). The segmentation accuracy for anatomical landmarks was within an acceptable range (median error: 1.7-4.1 mm). The inter-rater reliability between the proposed DL model and individual experts was fair to good for measurements of spinal curvature characteristics (all ICC values > 0.62). The developed DL model in this study demonstrated good levels of inter-rater reliability for predicting anatomical landmark positions and measuring radiographic alignment and spinal-pelvic parameters. Automated segmentation and analysis of whole-spine lateral radiographs using deep learning offers a promising tool to enhance accuracy and efficiency in orthopedic diagnostics and treatments.

Correlation Between Quantitative Background Suppression on EEG and Serum NSE in Patients With Hypoxic-ischemic Encephalopathy.

PURPOSE: We evaluated the correlation between quantitative background activities on electroencephalography (EEG) and serum neuron specific enolase (NSE) in patients with hypoxic-ischemic encephalopathy as well as a diagnostic value of prognostication. METHODS: This retrospective cohort study enrolled patients with return of spontaneous circulation after cardiac arrest from March 2010 to March 2020. The inclusion criteria were (1) older than the age of 16 years and (2) patients who had both EEG and NSE. The median time for EEG and NSE were 3 days (interquartile range 2-5 days) and 3 days (interquartile range 2-4 days), respectively. The quantification of background activity was conducted with the suppression ratio (SR). We used a machine learning (eXtreme Gradient Boosting algorithm) to evaluate whether the SR could improve the accuracy of prognostication. RESULTS: We enrolled 151 patients. The receiver operating characteristic analysis revealed a cut-off value of serum NSE and the SR for poor outcome, serum NSE (>31.9 µg/L, area under curve [AUC] = 0.88), and the SR (>21.5%, AUC = 0.75 in the right hemisphere, >34.4%, AUC = 0.76 in the left hemisphere). There was a significant positive correlation between the severity of SR and the level of NSE (ρ = 0.57, p < 0.0001 for the right hemisphere, ρ = 0.58, p < 0.0001 for the left hemisphere). The SR showed an excellent diagnostic value for predicting poor outcome (93% specificity, 60% sensitivity in the right hemisphere and 93% specificity, 58% sensitivity in the left hemisphere). With machine learning analysis, there was an increment in distinguishing the neurological outcome by adding SR on clinical factors. CONCLUSIONS: The SR showed a positive correlation with the level of serum NSE. The diagnostic value of the SR for predicting poor outcome was excellent, suggesting that it can be a possible biomarker for neuroprognostication in patients with hypoxic-ischemic encephalopathy.

Concept analysis of uncertainty in people with mental disabilities.

PURPOSE: This concept analysis clarified "uncertainty in people with mental disabilities". METHODS: The research was conducted using Walker & Avant's conceptual analysis methodology. RESULTS: Uncertainty in people with mental disabilities showed the defining attributes of "ambiguity," "unpredictability," "distrust," and "lack of insight into illness," of which "distrust" and "lack of insight" were unique to people with mental disabilities. Accordingly, it was defined as a state in which it is difficult to determine the treatment's timing because (1) the disease process is often too ambiguous to make a decision; (2) abnormal behavior can recur at any time while the patients are under treatment and in recovery; and (3) patients struggle to accept the illness, tend to distrust healthcare professionals and family, and show lack of knowledge, making them miss their treatment's timing and even making the expectation for recovery vague. CONCLUSION: The attributes of uncertainty in people with mental disabilities identified in this study confirmed that mental health professionals should proactively intervene to treat patients at an appropriate time and continuously manage them to prevent recurrence. PRACTICE IMPLICATION: The study findings can be utilized in mental health research and in developing interventions to reduce uncertainty in people with mental disabilities, helping them recover and integrate into the community.

Inhibitory Effect of Avenanthramides (Avn) on Tyrosinase Activity and Melanogenesis in α-MSH-Activated SK-MEL-2 Cells: In Vitro and In Silico Analysis.

Melanin causes melasma, freckles, age spots, and chloasma. Anti-melanogenic agents can prevent disease-related hyperpigmentation. In the present study, the dose-dependent tyrosinase inhibitory activity of Avenanthramide (Avn)-A-B-C was demonstrated, and 100 µM Avn-A-B-C produced the strongest competitive inhibition against inter-cellular tyrosinase and melanin synthesis. Avn-A-B-C inhibits the expression of melanogenesis-related proteins, such as TRP1 and 2. Molecular docking simulation revealed that AvnC (-7.6 kcal/mol) had a higher binding affinity for tyrosinase than AvnA (-7.3 kcal/mol) and AvnB (-6.8 kcal/mol). AvnC was predicted to interact with tyrosinase through two hydrogen bonds at Ser360 (distance: 2.7 Å) and Asn364 (distance: 2.6 Å). In addition, AvnB and AvnC were predicted to be skin non-sensitizers in mammals by the Derek Nexus Quantitative Structure-Activity Relationship system.

[Development of Job-Esteem Scale for Korean Nurses].

PURPOSE: The purpose of this study was to develop the Job Esteem Scale for Korean Nurses (JES-KN) and verify its validity and reliability. METHODS: Preliminary items were based on the attributes and indicators elicited from a concept analysis study on Korean nurses' job-esteem. The final preliminary tool for the main survey was confirmed through the content validity test of 10 experts and preliminary survey of 20 hospital nurses. The final preliminary scale was used on 350 hospital nurses in the scale testing phase for the main survey designed to test the validity and reliability of the scale. RESULTS: The final scale consisted of 28 items and 6 factors, these factor explained 66.6% of the total variance. The correlation between the total score and factors ranged from .64 and .84, validating that each sub-factor is suitable to explain job esteem. The correlation coefficient between this scale and the Job Satisfaction Scale for Clinical Nurses ranged from .41 to .70, and the internal consistency for the scale using Cronbach's α for the total items was .94. CONCLUSION: The JES-KN is a valid and reliable tool that reflects the reality of clinical sites accordingly. The JES-KN may well be used effectively to assess and evaluate the job esteem of Korean nurses.

Awareness of occupational hazards and personal protective equipment use among dental hygienists.

Background: The aim of this study was to evaluate the awareness of occupational hazards and personal protective equipment use among dental hygienists (DHs). Methods: A total of 271 self-administered questionnaires were obtained from 280 DHs working at dental hospitals or clinics in Daegu and Gyeongsangbuk-do, Korea. Results: The occupational hazards included work involving dust (94.1%), volatile substances (86.0%), noise (97.0%), and light-curing units (96.7%). The proportion of dental hygiene tasks that participants perceived as harmful were 42.4%, 51.7%, 9.2%, and 31.4% in the same order as above. The proportion of participants who used dust-proof masks during work involving dust was 1.1%. Those who wore gas-proof masks and gloves for work using volatile substances were 0.7% and 31.2%, respectively. Participants who used goggles for work involving light-curing units were 31.0%. None of the participants used ear plugs for work involving noise. A total of 22.9% of the participants recognized the Material Safety Data Sheet, while 79.7% had never been educated about harmful work environments. Conclusion: When compared to exposure status and perception of occupational hazards, the level of protective equipment use was very low. Extra measures to increase DHs' use of personal protective equipment are necessary.

A case of pemphigus vulgaris associated with ulcerative colitis.

Pemphigus vulgaris is an autoimmune bullous disorder characterized by the production of autoantibodies against the intercellular space of the epithelium. It has rarely been reported in association with inflammatory bowel disease. Ulcerative colitis is one of the forms of inflammatory bowel disease. A 62-year-old woman who had been treated for ulcerative colitis for 16 years developed pruritic bullae on the skin of her face and body. Histological findings and direct immunofluorescence examination of the skin showed pemphigus vulgaris. She was treated with systemic steroids, mesalazine, and azathioprine. Her cutaneous lesions have remained in remission and her ulcerative colitis has remained well-controlled. The relationship between pemphigus vulgaris and ulcerative colitis is unclear. An autoimmune response has been suspected in the pathogenesis of ulcerative colitis. Pemphigus vulgaris is also associated with an autoimmune mechanism. To our knowledge, this is the first case of ulcerative colitis associated with pemphigus vulgaris reported in Korea. The association may be causal.

The Effects of Epigallocatechin-3-Gallate and Mechanical Stimulation on Osteogenic Differentiation of Human Mesenchymal Stem Cells: Individual or Synergistic Effects.

This study aims to investigate the roles and effects of EGCG (epigallocatechin-3-gallate) during the osteogenic differentiation of human mesenchymal stem cells (hMSCs) in vitro. Recent studies have shown that proper mechanical stimuli can induce osteogenic differentiation of hMSCs apart from biochemical factors. In this study, the hMSC cultures were subjected to: (1) 25 uM EGCG alone or (2) 3% mechanical stretching (0.2 Hz for 4 h/day for 4 days) or (3) in combination with 3% mechanical stretching (0.2 Hz for 4 h/day for 4 days). The two factors were applied to the cell cultures separately and in combination to investigate the individual and synergistic effect of both mechanical stimulation and ECGC in the osteogenic differentiation of hMSCs. Utilizing real time PCR, we measured various osteogenic markers and even those related to intracellular signalings. Further investigation of mitochondria was performed that mitochondria biogenesis, antioxidant capacity, and morphological related markers were measured. hMSCs were to be osteogenic or myogenic differentiated when they were under 3% stretching only. However, when EGCG was applied along with stretching they were to be osteogenic differentiated rather than to be myogenic differentiated. This was supported by evaluating intracellular signalings: BMP-2 and VEGF. Therefore, the synergistical effects of simultaneous employment of stretching and EGCG on osteogenic differentiation were confirmed. Moreover, simultaneous employment was found positive in mitochondria biogenesis, antioxidant capacity, and morphological changes. Through this study, we came into the conclusion that the combination of proper mechanical stretching, 3% in this study, and EGCG promote osteogenic differentiation. Reflecting that EGCG can be obtained from plants not from the chemical syntheses, it is worth to be studied further either by animal tests or long-term experiments for clinical applications.

Changes, and the Relevance Thereof, in Mitochondrial Morphology during Differentiation into Endothelial Cells.

The roles of mitochondria in various physiological functions of vascular endothelial cells have been investigated extensively. Morphological studies in relation to physiological functions have been performed. However, there have been few reports of morphological investigations related to stem cell differentiation. This was the first morphological study of mitochondria in relation to endothelial differentiation and focused on quantitative analysis of changes in mitochondrial morphology, number, area, and length during differentiation of human mesenchymal stem cells (hMSCs) into endothelial-like cells. To induce differentiation, we engaged vascular endothelial growth factors and flow-induced shear stress. Cells were classified according to the expression of von Willebrand factor as hMSCs, differentiating cells, and almost fully differentiated cells. Based on imaging analysis, we investigated changes in mitochondrial number, area, and length. In addition, mitochondrial networks were quantified on a single-mitochondrion basis by introducing a branch form factor. The data indicated that the mitochondrial number, area per cell, and length were decreased with differentiation. The mitochondrial morphology became simpler with progression of differentiation. These findings could be explained in view of energy level during differentiation; a higher level of energy is needed during differentiation, with larger numbers of mitochondria with branches. Application of this method to differentiation into other lineages will explain the energy levels required to control stem cell differentiation.

The Association of Serum Cystatin C with Glycosylated Hemoglobin in Korean Adults.

BACKGROUND: Cystatin C has been known to be associated not only with early renal impairment but also with the incidence of diabetic conditions (prediabetes plus diabetes). However, it is not clear whether cystatin C levels are associated with the prevalence of diabetic conditions in Asian populations. We evaluated this association using glycosylated hemoglobin (HbA1c) levels as the definition of diabetes in Korean adults. METHODS: We analyzed data from 1,559 Korean adults (937 men and 622 women) with available serum cystatin C and HbA1c values. RESULTS: The serum cystatin C levels in subjects with prediabetes and diabetes were significantly increased (0.91±0.14 mg/L in prediabetes and 0.91±0.17 mg/L in diabetes vs. 0.88±0.13 mg/L in patients with normal glucose levels, P=0.001). At increasing cystatin C levels, the prevalence of subjects with prediabetes (30.2% vs. 14.6%, P<0.001) and those with diabetes (10.6% vs. 8.0%, P<0.001) significantly increased in the group with the highest cystatin C levels. The group with the highest cystatin C levels had a significantly increased odds ratio (OR) for the presence of diabetic conditions compared to the group with the lowest values in total subjects (OR, 2.35; 95% confidence interval [CI], 1.54 to 3.58; P<0.001) and in women (OR, 4.13; 95% CI, 1.97 to 8.65; P<0.001), though there was no significant increase after adjusting for multiple variables. CONCLUSIONS: Higher levels of serum cystatin C are associated with an increased prevalence of diabetic conditions in Korean adults. Our findings may extend the positive association of cystatin C with diabetes incidence to an Asian population.

A possible complementary tool for diagnosing tuberculosis: a feasibility test of immunohistochemical markers.

Differentiation of tuberculous granuloma (TG) from non-tuberculous granuloma (NG) is histopathologically difficult. We evaluated the usefulness of selected immunohistochemical markers to differentiate tuberculous granuloma (TG) and non-tuberculous granuloma (NG). We selected six biomarkers (FoxP3, TNF-beta, E-selectin [ESEL], indoleamine 2,3-dioxygenase [IDO], lactoferrin [LACT], and tartrate-resistant acid phosphatase [TRAP]) and immunohistochemically analyzed their expression in the presence of two types of granulomatous tissue samples, TG (n = 36) and NG (n = 31), using a microarray format. Three of those six biomarkers (LACT, IDO, and TNF-beta) were moderately accurate in discriminating TG from NG, individually and in combination, according to ROC analysis (AUC = 0.7-0.89, sensitivity = 55.6-77.8%, specificity = 71.0-100%). Our data indicate that selected immunohistochemical markers (LACT, IDO, and TNF-beta) can be used in ancillary tests to differentiate TG from NG in tissue samples. Further large-scale studies are required to validate our results.

Anti-carcinogenic effects of non-polar components containing licochalcone A in roasted licorice root.

BACKGROUND/OBJECTIVE: Licorice has been shown to possess cancer chemopreventive effects. However, glycyrrhizin, a major component in licorice, was found to interfere with steroid metabolism and cause edema and hypertension. The roasting process of licorice modifies the chemical composition and converts glycyrrhizin to glycyrrhetinic acid. The purpose of this study was to examine the anti-carcinogenic effects of the ethanol extract of roasted licorice (EERL) and to identify the active compound in EERL. MATERIALS/METHODS: Ethanol and aqueous extracts of roasted and un-roasted licorice were prepared. The active fraction was separated from the methylene chloride (MC)-soluble fraction of EERL and the structure of the purified compound was determined by nuclear magnetic resonance spectroscopy. The anti-carcinogenic effects of licorice extracts and licochalcone A was evaluated using a MTT assay, Western blot, flow cytometry, and two-stage skin carcinogenesis model. RESULTS: EERL was determined to be more potent and efficacious than the ethanol extract of un-roasted licorice in inhibiting the growth of DU145 and MLL prostate cancer cells, as well as HT-29 colon cancer cells. The aqueous extracts of un-roasted and roasted licorice showed minimal effects on cell growth. EERL potently inhibited growth of MCF-7 and MDA-MB-231 breast, B16-F10 melanoma, and A375 and A2058 skin cancer cells, whereas EERL slightly stimulated the growth of normal IEC-6 intestinal epithelial cells and CCD118SK fibroblasts. The MC-soluble fraction was more efficacious than EERL in inhibiting DU145 cell growth. Licochalcone A was isolated from the MC fraction and identified as the active compound of EERL. Both EERL and licochalcone A induced apoptosis of DU145 cells. EERL potently inhibited chemically-induced skin papilloma formation in mice. CONCLUSIONS: Non-polar compounds in EERL exert potent anti-carcinogenic effects, and that roasted rather than un-roasted licorice should be favored as a cancer preventive agent, whether being used as an additive to food or medicine preparations.

Hazardous metal pollution in the republic of fiji and the need to elicit human exposure.

The fact that hazardous metals do not bio-degrade or bio-deteriorate translates to long-lasting environmental effects. In the context of evidently rapid global industrialization, this ought to warrant serious caution, particularly in developing countries. In the Republic of Fiji, a developing country in the South Pacific, several different environmental studies over the past 20 years have shown levels of lead, copper, zinc and iron in sediments of the Suva Harbor to be 6.2, 3.9, 3.3 and 2.1 times more than the accepted background reference levels, respectively. High levels of mercury have also been reported in lagoon shellfish. These data inevitably warrant thorough assessment of the waste practices of industries located upstream from the estuaries, but in addition, an exposure and health impact assessment has never been conducted. Relevant government departments are duty-bound, at least to the general public that reside in and consume seafood from the vicinities of the Suva Harbor, to investigate possible human effects of the elevated hazardous metal concentrations found consistently in 20 years of surface sediment analysis. Furthermore, pollution of the intermediate food web with hazardous metals should be investigated, regardless of whether human effects are eventually confirmed present or not.

Increased frequency of osteoporosis and BMD below the expected range for age among South Korean women with rheumatoid arthritis.

OBJECTIVE: To compare the frequency of osteoporosis and bone mineral density (BMD) below the expected range for age between female patients with rheumatoid arthritis (RA) and healthy subjects and to determine risk factors for bone loss in female patients with RA. METHOD: Two hundred and ninety-nine patients with RA and 246 age-matched healthy subjects were included in this study. BMD in the lumbar spine, femoral neck and total hip were measured with dual-energy X-ray absorptiometry. A T-score of -2.5 or lower in postmenopausal women was defined as osteoporosis, and a Z-score -2.0 or lower in females prior to menopause was defined as below the expected range for age. RESULT: The frequency of osteoporosis in the RA patients (22.1%) was significantly higher than in healthy subjects (11.4%) at either the spine or hip (P = 0.014). The occurrence of BMD below the expected range for age in RA patients (7.8%) was also significantly higher than in healthy subjects (1.0%, P = 0.015). In 299 female patients with RA, higher age, lower body mass index and postmenopausal status were significantly associated with the lumbar spine and hip BMD reduction. Of disease-related variables, glucocorticoid use was independently associated with reduction of hip BMD. CONCLUSION: The prevalence of osteoporosis in the RA patients was 1.9 times higher than in healthy subjects. Glucocorticoid use was a risk factor for generalized bone loss in female RA patients.

The effects of designed angiopoietin-1 variant on lipid droplet diameter, vascular endothelial cell density and metabolic parameters in diabetic db/db mice.

Metabolic syndrome consists of metabolic abnormality with central obesity, hypertriglyceridemia, insulin resistance and hypertension. Adipose tissue has been known as a primary site of insulin resistance and its adipocyte size may be correlated with the degree of insulin resistance. A designed angiopoietin-1, COMP-Angiopoietin-1 (COMP-Ang1), mitigated high-fat diet-induced insulin resistance in skeletal muscle. In this study, we examined effects of COMP-Ang1 on adipocyte droplet size, vascular endothelial cell density in adipose tissue and metabolic parameters in db/db mice by administering COMP-Ang1 or LacZ (as a control) adenovirus. Administration of COMP-Ang1 decreased fat droplet diameter in epididymal and abdominal visceral adipocyte and visceral fat content in db/db mice. The density of vascular endothelial cell in adipose tissue was increased in db/db mice after treatment with COMP-Ang1. Serum resistin and tumor necrosis factor-α level was lower after treatment with COMP-Ang1 in db/db mice. COMP-Ang1 caused a restoration of fasting glycemic control in db/db mice and decreased serum insulin level and insulin resistance measured by HOMA index. These findings indicate that COMP-Ang1 regulates adipocyte fat droplet diameter, vascular endothelial cell density and metabolic parameters in db/db mice.

Change in the electroencephalogram delta wave in the frontal cranial region of rats with the hyperventilation.

Hyperventilation is one way to cause activation on the electroencephalogram (EEG) to diagnose brain disorders. The hyperventilation is also known to affect on the delta power in EEG. This study divided the total delta wave into low, middle, and high bands corresponding to the wave frequency. The power in these three delta wave bands was examined in the frontal cranial region of adult male Sprague-Dawley rats hyperventilated with ventilation (VE) of 360, 540, and 720 ml/min for 5 min. The control group was ventilated normally with a volume of 160 ml/min. The results show that the relative power of the low delta band in the rats hyperventilated at 360 ml/min VE was significantly increased compared with powers of pre-hyperventilation (p<0.05). The relative power of the middle delta band was not significantly affected by hyperventilation at any VE, and in the high delta band, all of the relative powers were decreased significantly in all hyperventilated rats compared with powers of pre-hyperventilation (p<0.05). We concluded that hyperventilation affects the frontal cranial region, by increasing the low delta band and decreasing the high delta band.

Multiple stress fractures of the lower extremity in healthy young men.

Stress fractures result from abnormal stresses imposed on normal bones by the continued and repeated actions of muscles or from normal stresses imposed on abnormal bones. The risk factors that can cause such stress fractures include excessive use, such as, in soldiers or athletes, nutritional deficiencies, and endocrine disorders. In addition, disease may arise from long-standing rheumatoid arthritis, osteoporosis, corticosteroid therapy, joint stiffness or contracture, or the correction of angular deformity. In these cases, stress fractures may occur in one area or multiple areas. However, no case of multiple stress fractures in a young man who was not a professional athlete and who had no stress fracture risk factor, such as, an endocrine disease, has been previously reported.

Hexane/ethanol extract of Glycyrrhiza uralensis and its active compound isoangustone A induce G1 cycle arrest in DU145 human prostate and 4T1 murine mammary cancer cells.

Although licorice is known to exert anticarcinogenic effects, it contains large quantities of glycyrrhizin (GL), which causes severe hypertension. We have previously demonstrated that the hexane/ethanol extract of Glycyrrhiza uralensis (HEGU) contains no detectable GL and suppresses doxorubicin-induced apoptosis in H9c2 rat cardiac myoblasts. The principal objective of this study was to determine whether and by what mechanism HEGU and its active component, isoangustone A, inhibit cell-cycle progression in DU145 human prostate and 4T1 mouse breast cancer cells. HEGU and isoangustone A dose-dependently decreased DNA synthesis and induced G1 phase arrest in both DU145 and 4T1 cells. HEGU and isoangustone A reduced the levels of CDK2 and CDK4 as well as cyclin A and cyclin D1 proteins, and also induced a decrease in CDK2 activity. The addition of HEGU to drinking water significantly suppressed the orthotopic growth of 4T1 allografts and the expression of the proliferating nuclear cell antigen, CDK2 and CDK4 proteins in the tumor tissues. These results demonstrate the potential of HEGU containing isoangustone A as an antitumor agent.

Elastic modulus of a silicon thin film fabricated by nanotransfer printing.

Transfer printing, a promising method for fabricating multi-scale structures on various substrates such as semiconductors and polymers, has been used to fabricate flexible devices with performance superior to that of conventional organic flexible devices. Although thin films might be expected to suffer damage during the transfer printing process, no reports of the degradation of mechanical properties during transfer printing have been published. The change in mechanical properties before and after transfer printing should be evaluated in terms of reliability and design for transfer printing to be successful. We propose a method of fabricating freestanding 200-nm-thick single-crystal silicon (SCS) thin-film specimens using transfer printing in order to investigate the mechanical properties of the transferred SCS thin-film specimens. The fabrication method combines several techniques such as semiconductor manufacturing, liftoff, and transfer printing processes. The core technology in this method is the fabrication of freestanding SCS thin-film structures suspended between two fixed ends. The mechanical properties of the freestanding SCS thin-film structures were measured using a microtensile machine capable of optical strain measurement. The test results provide insight into device design and reliability evaluation of flexible electronics fabricated by nanotransfer printing.

Pandemic H1N1 influenza A viral infection complicated by atypical hemolytic uremic syndrome and diffuse alveolar hemorrhage.

We report here on a case of a 27-year-old man with atypical hemolytic uremic syndrome and diffuse alveolar hemorrhage associated with influenza A H1N1 infection. Treatment with oseltamivir, plasma exchange and hemodiafiltration for the hemolytic uremic syndrome and meticulous supportive care with steroid pulse therapy for the pulmonary alveolar hemorrhage was successful in this case. We discuss the relationship between hemolytic uremic syndrome and influenza A and the underlying immunologic factors that should be tested in a patient with atypical hemolytic uremic syndrome. We also discuss using steroid therapy for patients with H1N1-related diffuse alveolar hemorrhage.