Usefulness of serial measurement of the mean platelet volume to predict multipleorgan dysfunction syndrome in patients with severe trauma

Objective@#The early prediction of multiple organ dysfunction syndrome (MODS) in trauma patients and provision ofprompt treatment may improve their outcomes. We investigated the efficacy of the mean platelet volume (MPV) for predictingMODS in cases of severe trauma. @*Methods@#This retrospective, observational cohort study was performed with patients prospectively integrated in a criticalpathway of TRAUMA. We analyzed the severe trauma patients admitted to the emergency department (ED), based onthe Advanced Trauma Life Support guideline, between January 1, 2011 and May 31, 2017. The outcomes were developedfrom MODS at least 48 hours after ED admission. @*Results@#A total of 348 patients were enrolled. An increase in the MPV at 12 hours (odds ratio [OR], 2.611; P8.6 fL (OR, 4.831; P<0.001). The area under the receiver operating characteristic curve(AUROC) value of the MPV at 12 hours (0.751; 95% confidence interval [CI], 0.687-0.818; P<0.01) was not inferior thanthat of Acute Physiology and Chronic Health Evaluation II score, injury severity score, lactate, and total CO2 for predictingMODS. @*Conclusion@#MPV was an independent predictor of MODS development in severe trauma patients. Emergency physicianscan use the MPV as an ancillary biomarker for predicting MODS.

Associations between the HaeIII Single Nucleotide Polymorphism in the SLC2A1 Gene and Diabetic Nephropathy in Korean Patients with Type 2 Diabetes Mellitus

BACKGROUND: Diabetic nephropathy (DN) is the most serious microvascular complication of diabetes mellitus and is one of the leading causes of end stage renal failure. In previous studies, the contribution of genetic susceptibility to DN showed inconsistent results. In this study, we investigated the association between the solute carrier family 2 facilitated glucose transporter member 1 (SLC2A1) HaeIII polymorphism and DN in Korean patients with type 2 diabetes mellitus (T2DM) according to disease duration. METHODS: A total of 846 patients with T2DM (mean age, 61.3 ± 12.3 years; mean duration of T2DM, 10.3 ± 7.9 years; 55.3% men) who visited the Chungbuk National University Hospital were investigated. The HaeIII polymorphism of the SLC2A1 gene was determined by the real time polymerase chain reaction method. Genotyping results were presented as GG, AG, or AA. A subgroup analysis was performed according to duration of T2DM (≤ 10 years, < 10 years). RESULTS: The AG + AA genotype showed a significantly higher risk of DN compared with the GG genotype in patients with a type 2 DM duration less than 10 years (12.4% vs. 4.2%; P < 0.001). No significant differences were observed in terms of other diabetic complications, including retinopathy, peripheral neuropathy, cardiovascular disease, cerebrovascular disease or peripheral artery disease, according to the genotypes of the SLC2A1 HaeIII polymorphism. CONCLUSION: The SLC2A1 HaeIII polymorphism was associated with DN in Korean patients with T2DM, particularly in the group with a relatively short disease duration.

Lactate/albumin ratio for the prediction of the development of sepsis-induced acute kidney injury in the emergency department

OBJECTIVE: The early prediction of acute kidney injury (AKI) in sepsis and the provision of prompt treatment may improve the outcomes. This study investigated the efficacy of the lactate/albumin ratio (LAR) in predicting severe AKI in cases of septic shock. METHODS: This retrospective, observational cohort study was performed on patients integrated prospectively in a critical pathway of early-goal-directed therapy (EGDT)/SEPSIS. Adult patients with septic shock, who were admitted to the emergency department with a normal kidney function or stage 1 disease based on the Acute Kidney Injury Network classification between January 1, 2014 and September 30, 2017, were analyzed. The outcomes were the development of sepsis-induced severe AKI within 7 days. RESULTS: A total of 343 patients were enrolled. An increase in the LAR value at admission (odds ratio [OR], 1.85; P=0.001) was a strong independent predictor of the development of severe AKI. The increasing predictability of AKI was closely associated with a L/A ratio≥0.794 at admission (OR, 14.66; P < 0.001). The area under the receiver operating characteristic curve value of the L/A ratio (0.821; 95% confidence interval [CI], 0.774–0.861; P < 0.01) was higher than that of lactate (0.795; 95% CI, 0.747–0.838; P < 0.01) for predicting severe AKI (P=0.032). CONCLUSION: L/A ratio was found to be an independent predictor of the development of severe AKI in septic shock. The prognostic performance of the L/A ratio for predicting AKI of critically ill sepsis patients was superior to that of lactate measurements.

The usefulness of lactate as an early predictor of the severity of emergency department patients with postpartum hemorrhage

OBJECTIVE: Only a few studies have examined the role of lactate reflecting on tissue hypoperfusion determining the severity of postpartum hemorrhage (PPH) patients in the emergency department (ED). This study evaluated the utility of the arterial lactate level as a prognostic marker of severity in PPH patients admitted to an ED. METHODS: This retrospective, observational cohort study was conducted on patients integrated prospectively in a critical pathway of SPEED (Severance Protocol to save postpartum bleeding through Expeditious care Delivery). Adult primary PPH patients admitted to the ED between July 1, 2010 and March 31, 2017 were analyzed. The outcomes were the development of severe PPH including death, hysterectomy, surgical treatment, and massive transfusion. RESULTS: A total of 112 patients were enrolled in this study. An increase in the arterial lactate value was a strong independent predictor of severe PPH. The increasing predictability of severe PPH was closely associated with an arterial lactate ≥3.15 mL/L at admission (odds ratio, 13.870; P < 0.001). CONCLUSION: Lactate is an independent predictor of severe PPH and is suitable for a rapid and simple estimation of the severity of PPH. Emergency physicians can use lactate to determine the initial treatment strategies more precisely.

Extracorporeal Life Support in Treatment of Poisoning Patient: Systematic Review

PURPOSE: Extracorporeal life support (ECLS) is a term used to describe a number of modalities including extracorporeal membrane oxygenation (ECMO) to support cardiac and/or pulmonary systems. The purpose of this study is to review the available evidence regarding the effect of ECLS in patients with acute poisoning. METHODS: Electronic literature searches with PubMed, Embase, Cochrane library, and KoreaMed were conducted for identification of relevant studies addressing ECLS in treatment of acute poisoning. The literature search was conducted by two investigators in March, 2016 with publication language restricted to English and Korean. The toxic substance, technique of ECLS, and final outcome of each case were analyzed. RESULTS: The final analysis included 64 articles including 55 case reports. There were no articles classified according to a high level of evidence such as randomized trial and prospective cohort study. ECLS treatment was used in the management of patients poisoned with 36 unique substances. Venovenous ECMO was performed in 4 cases. Among the reported cases, 10 patients died despite treatment with ECLS. CONCLUSION: Evidence supporting ECLS for patients with acute poisoning is inadequate. However, many case reports suggest that early consideration of ECLS in poisoned patients with refractory cardiac arrest or hemodynamic compromise refractory to standard therapies may be beneficial.

Evaluation of the VE1 Antibody in Thyroid Cytology Using Ex Vivo Papillary Thyroid Carcinoma Specimens

BACKGROUND: Recently, VE1, a monoclonal antibody against the BRAFV600E mutant protein, has been investigated in terms of its detection of the BRAFV600E mutation. Although VE1 immunostaining and molecular methods used to assess papillary thyroid carcinoma in surgical specimens are in good agreement, evaluation of VE1 in thyroid cytology samples is rarely performed, and its diagnostic value in cytology has not been well established. In present study, we explored VE1 immunoexpression in cytology samples from ex vivo papillary thyroid carcinoma specimens in order to minimize limitations of low cellularity and sampling/targeting errors originated from thyroid fineneedle aspiration and compared our results with those obtained using the corresponding papillary thyroid carcinoma tissues. METHODS: The VE1 antibody was evaluated in 21 cases of thyroid cytology obtained directly from ex vivo thyroid specimens. VE1 immunostaining was performed using liquid-based cytology, and the results were compared with those obtained using the corresponding tissues. RESULTS: Of 21 cases, 19 classic papillary thyroid carcinomas had BRAFV600E mutations, whereas two follicular variants expressed wild-type BRAF. VE1 immunoexpression varied according to specimen type. In detection of the BRAFV600E mutation, VE1 immunostaining of the surgical specimen exhibited 100% sensitivity and 100% specificity, whereas VE1 immunostaining of the cytology specimen exhibited only 94.7% sensitivity and 0% specificity. CONCLUSIONS: Our data suggest that VE1 immunostaining of a cytology specimen is less specific than that of a surgical specimen for detection of the BRAFV600E mutation, and that VE1 immunostaining of a cytology specimen should be further evaluated and optimized for clinical use.

Henoch-Schonlein Purpura in Children Hospitalized at a Tertiary Hospital during 2004-2015 in Korea: Epidemiology and Clinical Management / 대한소아소화기영양학회지

PURPOSE: To investigate the epidemiology, clinical manifestations, investigations and management, and prognosis of patients with Henoch-Schonlein purpura (HSP). METHODS: We performed a retrospective review of 212 HSP patients under the age of 18 years who were admitted to Inje University Sanggye Paik Hospital between 2004 and 2015. RESULTS: The mean age of the HSP patients was 6.93 years, and the ratio of boys to girls was 1.23:1. HSP occurred most frequently in the winter (33.0%) and least frequently in the summer (11.3%). Palpable purpura spots were found in 208 patients (98.1%), and gastrointestinal (GI) and joint symptoms were observed in 159 (75.0%) and 148 (69.8%) patients, respectively. There were 57 patients (26.9%) with renal involvement and 10 patients (4.7%) with nephrotic syndrome. The incidence of renal involvement and nephrotic syndrome was significantly higher in patients with severe GI symptoms and in those over 7 years old. The majority of patients (88.7%) were treated with steroids. There was no significant difference in the incidence of renal involvement or nephrotic syndrome among patients receiving different doses of steroids. CONCLUSION: In this study, the epidemiologic features of HSP in children were similar to those described in previous studies, but GI and joint symptoms manifested more frequently. It is essential to carefully monitor renal involvement and progression to chronic renal disease in patients ≥7 years old and in patients affected by severe GI symptoms. It can be assumed that there is no direct association between early doses of steroids and prognosis.

Comparisons of Clinical Characteristics Affecting Readmission between Late Preterm Infants and Moderate Preterm Infants or Full-Term Infants

PURPOSE: We aimed to describe the differences in clinical characteristics that affect readmission between late and moderate preterm or full-term infants. METHODS: Medical records were reviewed for 881 patients with gestational ages of ≥31⁺⁰ weeks who were born at Inje University Sanggye Paik Hospital between1 January 2013 and 20 September 2015. The patients were categorized into three subgroups as follows moderate preterm infants: those born at 31-33 weeks' gestation (n=73), late preterm infants: those born at 34–36 weeks' gestation (n=169),and full-term infants: those born at ≥37 weeks' gestation (n=639). We compared the late and moderate preterm or full-term infants in terms of clinical characteristics that affect readmission. RESULTS: The readmission rate was 18.9% in the late preterm infants, 21.9% in the moderate preterm infants, and 16.7% in the full-term infants. The independent risk factors of readmission were gestational age in the late preterm infants, positive pressure ventilation at birth in the moderate preterm infants, and air-leak syndrome in the full-term infants. In addition, antenatal care at the first trimester of pregnancy was an independent protective factor against readmission in the full-term infants. CONCLUSION: Our results suggest that gestational age may affect the readmission rate of late preterm infants.

Acute Resistance Exercise Attenuates the Cardiovascular Reactivity to Cold Pressor Test in Healthy Adults / 대한스포츠의학회지

Increased cardiovascular reactivity to sympathetic challenge is associated with increased risk of hypertension and cardiovascular disease. Acute aerobic exercise blunts stress related cardiovascular reactivity, but whether acute resistance exercise attenuates cardiovascular reactivity is unknown. We tested the hypothesis that acute resistance exercise will attenuate hemodynamic reactivity to a cold pressor test in healthy adults. Using a randomized cross-over trial, 20 healthy adults (9 males, 11 females; age, 26±5 years; body mass index, 23.85±3.19 kg/m2) completed two testing sessions, separated by 1 week. Sessions consisted of either a control condition or an acute resistance exercise prior to cold pressor testing (two sets, eight exercises, 40%-60% of 1 repetition maximum for upper and lower extremity). Blood pressure and heart rate measured at baseline, 30 seconds, and 120 seconds during a 3-minute cold pressor test (ice water, 4℃), and 30 seconds and 120 seconds post-cold pressor testing, respectively. During the cold pressor test, there were significant increases in blood pressures and heart rate (p<0.05) in both groups. However, acute resistance exercise attenuated increases in systolic blood pressure, but not heart rate, compared with the control (all p<0.05 for interact effects). These findings show that the cold pressor test significantly increases blood pressures and heart rate in healthy adults, but an acute bout of resistance exercise attenuated the hemodynamic response to the cold pressor test. Therefore, resistance exercise may have a favorable effect on cardiovascular reactivity to sympathetic activation in healthy adults.

Pelvic Castleman's disease presenting as an adnexal tumor in a young woman

Castleman's disease (CD) is a rare benign disorder of unknown etiology characterized by proliferation of lymphoid tissues. Seventy percent of this tumor occurs in the mediastinum and it is seldom found in neck, pancreas or pelvis. We report a case of asymptomatic pelvic CD initially presenting as an adnexal tumor in a 27-year-old woman. Initial transvaginal sonography revealed 7-cm-sized hyperechoic mass adjacent to the right ovary and the following abdominal computed tomography scanning showed the same sized mass located on the right extraperitoneal pelvic cavity. Laparoscopic mass excision was performed without any complication and pathological diagnosis was made as CD. CD should be included in the differential diagnosis of female pelvic masses which are noted in the pelvic cavity. In this report, we review the clinicopathological findings in a presentation of CD.

Association of Monocyte Chemoattractant Protein-1 (MCP-1) 2518A/G Polymorphism with Proliferative Diabetic Retinopathy in Korean Type 2 Diabetes

PURPOSE: Monocyte chemoattractant protein-1 (MCP-1) is a chemokine that can increase adhesion molecule expression on monocytes and produce superoxide anions. Hyperglycemia induces MCP-1 production in vascular endothelial cells and retinal pigmented epithelial cells, and has been implicated as a causal factor in the facilitation of vascular complications in diabetes. In the present study, we evaluated the association of a single nucleotide polymorphism (SNP) in the MCP-1 gene with proliferative diabetic retinopathy (PDR) in a Korean population with type 2 diabetes. MATERIALS AND METHODS: We conducted a case-control study, which enrolled 590 subjects with type 2 diabetes, and SNP genotyping of c.2518A/G in the MCP-1 gene was performed using polymerase chain reaction followed by digestion with PvuII restriction enzyme. RESULTS: The prevalence of c.2518A/G polymorphism in diabetic patients was 13.2% (A/A), 47.1% (A/G) and 39.7% (G/G). In patients with diabetic retinopathy, the prevalence of PDR was significantly higher (p=0.009) in diabetic subjects with the c.2518A/A genotype (35.9%; n=78) compared to those with either the A/G or G/G genotype (22.3%, n=512). The prevalence of any other micro and macro-complications, including nephropathy and cerebrovascular events, were not different according to the c.2518A/G genotype. CONCLUSION: Our new genetic findings suggest that the c.2518A/A genotype in MCP-1 could be used as a susceptibility gene to predispose Koreans exhibiting type 2 diabetes for the development of PDR.

The Effects of Acute Resistance Exercise on Ischemia-Reperfusion Injury-Induced Macro and Microvascular Dysfunction in Healthy Young Adults / 대한스포츠의학회지

Ischemia reperfusion injury (IRI) leads to a temporary decrease in macrovascular function, but whether IRI causes microvascular dysfunction is not known. Resistance exercise involves muscular contractions that can make downstream tissues ischemic and may ischemic preconditioning the vasculature against endothelial IRI. We tested the hypothesis that an acute resistance exercise prior to IRI would prevent or attenuate IRI induced macro- and microvascular dysfunction in healthy young adults. Nineteen healthy young subjects (age 22+/-2 years) were randomly assigned to either a resistance exercise group (n=10) as a model to produce ischemic preconditioning or a control group (n=9). The resistance exercise was performed eight types of systemic resistance exercise. Ischemia was induced by inflating a cuff placed around the upper arm to 200 mm Hg for 20 minutes. carotid-femoral pulse wave velocity (cfPWV) as index of macrovascular function and reactive hyperemia index (RHI) using by fingertip arterial tonometry as index of microvascular function were measured at baselines and 15 and 30 minutes after ischemia reperfusion injury. cfPWV was increased in control group but decreased in resistance exercise group following IRI. There was a significant interaction effect between resistance exercise group and control group for cfPWV (p=0.022). The RHI was unaffected following IRI and also unchanged by a resistance exercise. These findings show that ischemia reperfusion caused macrovascular dysfunction but not microvascular dysfunction. However, this macrovascular dysfunction following IRI was not shown in the resistance exercise group. Thus, an acute bout of resistance exercise prior to ischemia may prevent against ischemia reperfusion injury induced macrovascular dysfunction.

A Case of Focal Segmental Glomerulosclerosis Associated with Renal Cell Carcinoma / 대한신장학회지

The association between malignancy and glomerular disease has been reported in older patients. Although the relationship between membranous glomerulonephritis or minimal change disease and solid tumors or hematologic malignancies, respectively, are known widely, focal segmental glomerulosclerosis have been described rarely in patients with solid tumors. We describe a patient with renal cell carcinoma who presented to nephrotic syndrome, volume overload and renal failure. On renal biopsy at contra-lateral kidney of renal cell carcinoma, the patient was diagnosed at focal segmental glomerulosclerosis. The proteinuria and renal function were ameliorated after resection renal cell carcinoma. We suggest that the focal segmental glomerulosclerosis is associated with renal cell carcinoma. This is the first case of the clinical cause of focal segmental glomerulosclerosis associated with renal cell carcinoma of papillary type.

Unilateral Breast Edema: Spectrum of Etiologies and Imaging Appearances

Breast edema is defined as a mammographic pattern of skin thickening, increased parenchymal density, and interstitial marking. It can be caused by benign or malignant diseases, as a result of a tumor in the dermal lymphatics of the breast, lymphatic congestion caused by breast, lymphatic drainage obstruction, or by congestive heart failure. Here we describe several conditions, that cause unilateral breast edema with the aim of familiarizing radiologists with these disease entities.

A Solitary Osteochondroma of the Pediatric Thoracic Spine: A Case Report / 대한척추외과학회지

An osteochondroma is a bone tumor, but rarely occurs in the thoracic spine, especially in the pediatric population. The objective of this study was to describe the diagnosis and successful treatment of a pediatric patient with an osteochondroma of the thoracic spinous process. The anteroposterior and lateral plain radiographs illustrated a well-defined solid mass arising from the spinous process of the tenth thoracic vertebrae. Computed tomography and magnetic resonance imaging further delineated that the mass arose from the spinous process, but with no obvious impingement of the nerve roots. After excision of the lesion, the gross pathological and histological evaluations were consistent with those of an osteochondroma. This led to appropriate surgical intervention, resulting in definitive treatment.

A Case of Retroperitoneal Mass in Infancy, Fetus in Fetus / 대한산부인과학회잡지

"Fetus in fetus" is a rare pathologic feature consisting of a parasitic twin included within the body of the other twin, which most likely arises from inclusion of a monozygotic, diamniotic twin pregnancy. The exact embryogenesis of fetus in fetus is controversial. Some investigators propose that it is a highly organized teratoma. Since the condition was first described by Meckel in the late 18th centry, approximately 100 cases have been reported in the literature. Most cases present as an abdominal mass during the first year of life, with a few cases being detected prenatally by ultrasound examination. So we report one case of fetus in fetus detected by ultrasound examination prenatally.

A Case of IgA Nephropathy Associated with LV Thrombus and Cerebral Infarction / 대한신장학회잡지

Thrombosis is one of the important complications in nephrotic syndrome and related to the hypercoagulable state of the nephrotic syndrome, although the exact mechanism is under the debate. While venous trombosis is frequently encountered, arterial thrombosis is rare. Renal vein thrombosis occurs frequently in the patients with nephrotic syndrome due to membranous glomerulonephritis (MGN), membranoproliferative glomerulonephritis (MPGN). It, however, rarely happens in IgA nephropathy. Intracardiac thrombus in the nephrotic syndrome have been described few in the earlier literatures. We reported a case of IgA nephropathy with LV thrombus and cerebral infarction that has been treated successfully with thrombolytic theraphy. So far, the patient on the outpatient clinics have reported no specific complaints.

A Case of Cantrell's Pentalogy with Anencephaly Diagnosed by Prenatal Ultrasonography / 대한산부인과학회잡지

Pentalogy of Cantrell was very rare congenital anomaly and represent a regional prevalence of 5.5/1 million live births. The syndrome, Cantrell's pentalogy is characterized by defects in the lower sternum with ectopia cordis, anterior diaphragm defects, midline supraumbilical abdominal wall defects, defects in the diaphragmatic pericardium, and various intracardiac defects. Anencephaly involves acrania with a degenerated mass of brain tissue. Combination of both conditions are extremely rare. We experienced a case of Cantrell's pentalogy with anencephaly detected by ultrasonography at 15 weeks 1 day menstural age and confirmed at autopsy. Thus we report a case with brief review of the literature.

Family Outbreak of Trichinosis After Eating a Raw Meat of Wild Swine

Trichinosis is a worldwide parasitic infection caused by ingesting an uncooked raw meat containing viable larvae of nematode Trichinella. Although most cases have been reported in Western countries, the incidence has decreased due to strict control of meat handlings and improved hygiene in these countries. In Korea, the first case of Trichinella spiralis was reported in a patient who ingested an uncooked badger. We have also experienced four cases of Trichinella spiralis infestation among family members who showed typical clinical manifestations and laboratory findings after ingesting raw wild swine meat, and herein report the finding.

Family Outbreak of Trichinosis After Eating a Raw Meat of Wild Swine

Trichinosis is a worldwide parasitic infection caused by ingesting an uncooked raw meat containing viable larvae of nematode Trichinella. Although most cases have been reported in Western countries, the incidence has decreased due to strict control of meat handlings and improved hygiene in these countries. In Korea, the first case of Trichinella spiralis was reported in a patient who ingested an uncooked badger. We have also experienced four cases of Trichinella spiralis infestation among family members who showed typical clinical manifestations and laboratory findings after ingesting raw wild swine meat, and herein report the finding.