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Background/Aims@#Sorafenib is the standard of care in the management of advanced hepatocellular carcinoma (HCC). The purpose of this study was to investigate the characteristics, treatment patterns and outcomes of sorafenib among HCC patients in South Korea. @*Methods@#This population-based retrospective, single-arm, observational study used the Korean National Health Insurance database to identify patients with HCC who received sorafenib between July 1, 2008, and December 31, 2014. A total of 9,923 patients were recruited in this study. @*Results@#Among 9,923 patients, 6,669 patients (68.2%) received loco-regional therapy prior to sorafenib, and 1,565 patients (15.8%) received combination therapy with concomitant sorafenib;2,591 patients (26.1%) received rescue therapy after sorafenib, and transarterial chemoembolization was the most common modality applied in 1,498 patients (15.1%). A total of 3,591 patients underwent rescue therapy after sorafenib, and the median overall survival was 14.5 months compared to 4.6 months in 7,332 patients who received supportive care after sorafenib. The mean duration of sorafenib administration in all patients was 105.7 days; 7,023 patients (70.8%) received an initial dose of 600 to 800 mg. The longest survival was shown in patients who received the recommended dose of 800 mg, subsequently reduced to 400 mg (15.0 months). The second longest survival was demonstrated in patients with a starting dose of 800 mg, followed by a dose reduction to 400–600 mg (9.6 months). @*Conclusions@#Real-life data show that the efficacy of sorafenib seems similar to that observed in clinical trials, suggesting that appropriate subsequent therapy after sorafenib might prolong patient survival.
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Purpose@#To retrospectively evaluate the chest computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) in patients with mild clinical symptoms at a single hospital in South Korea. @*Materials and Methods@#CT scans of 87 COVID-19 patients [43 men and 44 women; median age:41 years (interquartile range: 26.1–51.0 years)] with mild clinical symptoms (fever < 38℃ and no dyspnea) were evaluated. @*Results@#CT findings were normal in 39 (44.8%) and abnormal in 48 (55.2%) patients. Among the 48 patients with lung opacities, 17 (35.4%) had unilateral disease and 31 (64.6%) had bilateral disease. One (2.1%) patient showed subpleural distribution, 9 (18.8%) showed peribronchovascular distribution, and 38 (79.2%) showed subpleural and peribronchovascular distributions.Twenty-two (45.8%) patients had pure ground-glass opacities (GGOs) with no consolidation, 17 (35.4%) had mixed opacities dominated by GGOs, and 9 (18.8%) had mixed opacities dominated by consolidation. No patients demonstrated consolidation without GGOs. @*Conclusion@#The most common CT finding of COVID-19 in patients with mild clinical symptoms was bilateral multiple GGO-dominant lesions with subpleural and peribronchovascular distribution and lower lung predilection. The initial chest CT of almost half of COVID-19 patients with mild clinical symptoms showed no lung parenchymal lesions. Compared to relatively severe cases, mild cases were more likely to manifest as unilateral disease with pure GGOs or GGOdominant mixed opacities and less likely to show air bronchogram.
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Background@#This study aimed to determine the parameters for worsening oxygenation in non-severe coronavirus disease 2019 (COVID-19) pneumonia. @*Methods@#This retrospective cohort study included cases of confirmed COVID-19 pneumonia in a public hospital in South Korea. The worsening oxygenation group was defined as that with SpO2 ≤94% or received oxygen or mechanical ventilation (MV) throughout the clinical course versus the non-worsening oxygenation group that did not experience any respiratory event. Parameters were compared, and the extent of viral pneumonia from an initial chest computed tomography (CT) was calculated using artificial intelligence (AI) and measured visually by a radiologist. @*Results@#We included 136 patients, with 32 (23.5%) patients in the worsening oxygenation group; of whom, two needed MV and one died. Initial vital signs and duration of symptoms showed no difference between the two groups; however, univariate logistic regression analysis revealed that a variety of parameters on admission were associated with an increased risk of a desaturation event. A subset of patients was studied to eliminate potential bias, that ferritin ≥280 μg/L (p=0.029), lactate dehydrogenase ≥240 U/L (p=0.029), pneumonia volume (p=0.021), and extent (p=0.030) by AI, and visual severity scores (p=0.042) were the predictive parameters for worsening oxygenation in a sex-, age-, and comorbid illness-matched case-control study using propensity score (n=52). @*Conclusion@#Our study suggests that initial CT evaluated by AI or visual severity scoring as well as serum markers of inflammation on admission are significantly associated with worsening oxygenation in this COVID-19 pneumonia cohort.
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The myelination of axons in the vertebrate nervous system through oligodendrocytes promotes efficient axonal conduction, which is required for the normal function of neurons. The central nervous system (CNS) can regenerate damaged myelin sheaths through the process of remyelination, but the failure of remyelination causes neurological disorders such as multiple sclerosis. In mammals, parenchymal oligodendrocyte progenitor cells (OPCs) are known to be the principal cell type responsible for remyelination in demyelinating diseases and traumatic injuries to the adult CNS. However, growing evidence suggests that neural stem cells (NSCs) are implicated in remyelination in animal models of demyelination. We have previously shown that olig2+ + radial glia (RG) have the potential to function as NSCs to produce oligodendrocytes in adult zebrafish. In this study, we developed a zebrafish model of adult telencephalic injury to investigate cellular and molecular mechanisms underlying the regeneration of oligodendrocytes. Using this model, we showed that telencephalic injury induced the proliferation of olig2+ + RG and parenchymal OPCs shortly after injury, which was followed by the regeneration of new oligodendrocytes in the adult zebrafish. We also showed that blocking Notch signaling promoted the proliferation of olig2+ RG and OPCs in the normal and injured telencephalon of adult zebrafish. Taken together, our data suggest that Notch-regulated proliferation of olig2+ RG and parenchymal OPCs is responsible for the regeneration of oligodendrocytes in the injured telencephalon of adult zebrafish.
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Purpose@#The safety and efficacy of laparoscopic cholecystectomy (LC) in elderly patients is a matter of concern because morbidity and clinical risk are higher in elderly patients; and some clinicians recommend non-surgical supportive treatments. There is limited data reported in the literature for LC in super-elderly individuals (aged ≥ 80 years). This study compared the clinical outcome for the elderly and super-elderly patients undergoing LC. @*Methods@#Patients who had a cholecystectomy for acute or chronic cholecystitis, and empyema of the gall bladder between January 2011 and June 2018 were analyzed retrospectively. The clinical outcomes of the super-elderly patients (≥ 80 years, Group 2) were compared with elderly patients (65-79 years, Group 1). Complications, conversion rate, postoperative hospital stays were assessed. @*Results@#The conversion rate was 5.5% and 8.4% in Groups 1 and 2, respectively (p = 0.749). The surgical or medical complication rates were similar in both groups. A significant difference in operation time was observed between groups (p < 0.001). Although the super-elderly patients had longer postoperative hospital stays (7.10 ± 6.98) than the elderly patients (4.60 ± 6.06), there was no significant difference with between the 2 groups (p = 1.000). @*Conclusion@#The clinical outcomes of the conversion rate, complications, and mortality were similar in patients aged 65 to 79 years and ≥ 80 years. Therefore, LC is deemed to be a safe and simple procedure for the super-elderly.
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Purpose@#The safety and efficacy of laparoscopic cholecystectomy (LC) in elderly patients is a matter of concern because morbidity and clinical risk are higher in elderly patients; and some clinicians recommend non-surgical supportive treatments. There is limited data reported in the literature for LC in super-elderly individuals (aged ≥ 80 years). This study compared the clinical outcome for the elderly and super-elderly patients undergoing LC. @*Methods@#Patients who had a cholecystectomy for acute or chronic cholecystitis, and empyema of the gall bladder between January 2011 and June 2018 were analyzed retrospectively. The clinical outcomes of the super-elderly patients (≥ 80 years, Group 2) were compared with elderly patients (65-79 years, Group 1). Complications, conversion rate, postoperative hospital stays were assessed. @*Results@#The conversion rate was 5.5% and 8.4% in Groups 1 and 2, respectively (p = 0.749). The surgical or medical complication rates were similar in both groups. A significant difference in operation time was observed between groups (p < 0.001). Although the super-elderly patients had longer postoperative hospital stays (7.10 ± 6.98) than the elderly patients (4.60 ± 6.06), there was no significant difference with between the 2 groups (p = 1.000). @*Conclusion@#The clinical outcomes of the conversion rate, complications, and mortality were similar in patients aged 65 to 79 years and ≥ 80 years. Therefore, LC is deemed to be a safe and simple procedure for the super-elderly.
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Purpose@#The purpose of this study was to identify the effects of ego-resilience, nursing professionalism and empathy on clinical competency and to suggest strategies for improving the clinical competency of general hospital nurses. @*Methods@#Data collection was performed from Jan. 18th, 2019 to Feb. 14th. A total of 194 nurses from four general hospitals participated in this study. The collected data were analyzed with descriptive statistics, t-test, ANOVA, Kruskal-Wallis test, Scheffe test, Pearson's correlation and stepwise multiple regression analysis using SPSS 23.0. @*Results@#The factors affecting the clinical competency of general hospital nurses included ego-resilience (β=.28, p<.001), nursing professionalism (β=.20, p=.011), empathic concern (β=.19, p=.003), working department (β=-.17, p=.008), total clinical career (β=.15, p=.011), and number of beds (β=.13, p=.033). These factors accounted for 33.0% of the clinical competency (p<.001). @*Conclusion@#It is important to find ways to improve the level of empathy of general hospital nurses and there is a need to include education programs or practical interventions to strengthen empathy at the clinical level.
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The myelination of axons in the vertebrate nervous system through oligodendrocytes promotes efficient axonal conduction, which is required for the normal function of neurons. The central nervous system (CNS) can regenerate damaged myelin sheaths through the process of remyelination, but the failure of remyelination causes neurological disorders such as multiple sclerosis. In mammals, parenchymal oligodendrocyte progenitor cells (OPCs) are known to be the principal cell type responsible for remyelination in demyelinating diseases and traumatic injuries to the adult CNS. However, growing evidence suggests that neural stem cells (NSCs) are implicated in remyelination in animal models of demyelination. We have previously shown that olig2+ + radial glia (RG) have the potential to function as NSCs to produce oligodendrocytes in adult zebrafish. In this study, we developed a zebrafish model of adult telencephalic injury to investigate cellular and molecular mechanisms underlying the regeneration of oligodendrocytes. Using this model, we showed that telencephalic injury induced the proliferation of olig2+ + RG and parenchymal OPCs shortly after injury, which was followed by the regeneration of new oligodendrocytes in the adult zebrafish. We also showed that blocking Notch signaling promoted the proliferation of olig2+ RG and OPCs in the normal and injured telencephalon of adult zebrafish. Taken together, our data suggest that Notch-regulated proliferation of olig2+ RG and parenchymal OPCs is responsible for the regeneration of oligodendrocytes in the injured telencephalon of adult zebrafish.
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Background@#A novel antiviral agent, remdesivir (RDV), is a promising candidate treatment for coronavirus disease 2019 (COVID-19) in the absence of any proven therapy.Materials and @*Methods@#This retrospective case series included 10 patients with a clinically and laboratory confirmed diagnosis of severe COVID-19 pneumonia who had received RDV for 5 days (n = 5) or 10 days (n = 5) in the Phase III clinical trial of RDV (GS-US-540-5773) conducted by Gilead Sciences. The clinical and laboratory data for these patients were extracted. @*Results@#One patient in the 10-day group received RDV for only 5 days because of nausea and elevated liver transaminases. No patient had respiratory comorbidity. Seven patients had bilateral lesions and three had unilateral lesions on imaging. All patients had received other medications for COVID-19, including lopinavir/ritonavir and hydroxychloroquine, before administration of RDV. Five patients required supplemental oxygen and one required mechanical ventilation. All patients showed clinical and laboratory evidence of improvement.Half of the patients developed elevated liver transaminases and three had nausea. There were no adverse events exceeding grade 2. @*Conclusion@#Our experience indicates that RDV could be a therapeutic option for COVID-19.A well-designed randomized controlled clinical trial is now needed to confirm the efficacy of RDV in patients with COVID-19.
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In view of this pandemic, as of February 2020, South Korea has the second highest number of confirmed cases in the world. Herein, we report four confirmed coronavirus disease 2019 (COVID-19) cases in the early stage of the pandemic in South Korea and describe the identification, diagnosis, clinical course, and management, including one patient’s initial mild symptoms at presentation and their progression to pneumonia on day 21 of illness. Within 48 hours of hospitalization, all four patients underwent evaluation for initial laboratory parameters, COVID-19 polymerase chain reaction (PCR), and chest computed tomography (CT) findings. All four mild COVID-19 patients were discharged, and they were re-examined 14 days after discharge. Despite all four of them being asymptomatic, one patient was re-admitted after confirmation of COVID-19 through PCR viral nucleic acid detection. She could be discharged after 7 days with two subsequent negative COVID-19 PCR at 24-hour intervals. Patients with mild COVID-19 generally have normal follow-up chest CT scans after discharge, even if the early chest CT definitely indicates pneumonia. Re-hospitalized patients with COVID-19 PCR positive results after discharge were not related to her initial chest CT, lab, symptoms compared other three patients.
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BACKGROUND: Previous randomized controlled trials of revascularization for atherosclerotic renal artery stenosis (ARAS) were not successful. We investigated the effects of percutaneous transluminal angioplasty with stent insertion (PTA/S) on kidney function and blood pressure (BP) control in patients with ARAS. METHODS: From 2000 to 2017, 47 subjects who underwent PTA/S for ARAS were identified. A high-risk group was defined, composed of patients having one or more of the following clinical presentations: pulmonary edema, refractory hypertension, and rapid deterioration of kidney function. Subjects who met the criteria of ‘kidney function improvement’ or ‘hypertension improvement’ after PTA/S were classified as responders. RESULTS: Twenty-one (44.7%) subjects were classified into the high-risk group. Two subjects (8.0%) in the low-risk group (n = 25) and 5 subjects (27.8%) in the high-risk group (n = 18) showed improvement in kidney function after PTA/S (P = 0.110). In patients with rapid decline of kidney function, estimated glomerular filtration rate improved from 28 (interquartile range [IQR], 10–45) mL/min/1.73 m² to 41 (IQR, 16–67) mL/min/1.73 m² at 4 months after PTA/S, although the difference was not significant (P = 0.084). Regarding BP control, 9 (36.0%) and 14 (77.8%) subjects showed improvement after PTA/S in the low- (n = 25) and high-risk (n = 18) groups, respectively (P = 0.007). In patients with refractory hypertension, the systolic BP dropped from 157 (IQR, 150–164) mmHg to 140 (IQR, 131–148) mmHg at 4 months after PTA/S (P = 0.005). Twenty-five subjects were defined as responders and comprised a significant proportion of the high-risk group (P = 0.004). CONCLUSION: PTA/S might improve BP control and kidney function in patients with ARAS presenting with high-risk clinical features. The optimal application of PTA/S should be based on individual assessment of the clinical significance of renal artery stenosis.
Subject(s)
Humans , Angioplasty , Blood Pressure , Glomerular Filtration Rate , Hypertension , Kidney , Pulmonary Edema , Renal Artery Obstruction , Renal Artery , StentsABSTRACT
PURPOSE@#This study was conducted to status and needs for continuing education for trauma hospital nurses in Korea.@*METHODS@#Thirty nurses from the seven level I trauma center hospitals or trauma treatment systems were randomly selected and surveyed. The survey was conducted from March 1 to May 31, 2017. Categorical data were analyzed with Pearson chi-square tests and Continuous variables were analyzed with ANOVA.@*RESULTS@#Only 86 out of 204 nurses had received continuing education (42.1%). The current status of continuing education programs, delivering institution (p<0.001), education method (p<0.001), education period (p=0.003), number of participants (p=0.007), and instructors (p=0.014) were also significantly different from trauma center to trauma center. There were 108 (52.9%) nurses who responded that continuing education programs were “needed†92 (45.1%) and “very much needed†16 (7.8%). According to each trauma center's characteristics were significantly differences in the need for continuing education (p=0.089), subject selection method (p<0.001) and the number of continuing education sessions (p=0.043) depending on the hospital.@*CONCLUSIONS@#It is necessary to consider differences between the hospitals to develop continuing education programs that reflect the needs of nurses, in order to improve the efficiency of and satisfaction with the educational programs.
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Hematopoietic stem cell transplantation (HSCT) causes many complications such as anorexia, nausea, vomiting, diarrhea, and mucositis. Most patients undergoing HSCT have risk for malnutrition in the process of transplantation so artificial nutrition support is required. The purpose of this case report is to share our experience of applying nutrition intervention during the transplantation period. According to HSCT process, the change of the patient's gastrointestinal symptoms, oral intake and nutritional status was recorded. By encouraging oral intake and providing parenteral nutrition, the patient had only 0.3%, losing weight during the transplantation period. In conclusion, it emphasized that the nutritional status changes during the HSCT period should be closely monitored and nutritional management through appropriate nutritional support and interventions in hospital and after discharge.
Subject(s)
Humans , Anorexia , Diarrhea , Hematopoietic Stem Cell Transplantation , Malnutrition , Mucositis , Nausea , Nutritional Status , Nutritional Support , Parenteral Nutrition , Peripheral Blood Stem Cell Transplantation , Precursor Cell Lymphoblastic Leukemia-Lymphoma , VomitingABSTRACT
Thymic cysts are uncommon benign lesions in the anterior mediastinum. We here describe a 55-year-old male with spontaneous thymic cyst hemorrhage manifesting as a rapidly enlarging mediastinal mass that was resected completely with video-assisted thoracoscopic surgery. To the best of our knowledge, this is the first report of a spontaneous thymic cyst hemorrhage in Korea. In cases of rapidly enlarging mediastinal masses, spontaneous thymic cyst hemorrhage should be considered as a differential diagnosis.
Subject(s)
Humans , Male , Middle Aged , Diagnosis, Differential , Hemorrhage , Korea , Mediastinal Cyst , Mediastinum , Thoracic Surgery, Video-AssistedABSTRACT
Tracheal hemangioma is a rare benign vascular tumor in adults. We reported a case of massive hemoptysis caused by a cavernous hemangioma in a 75-year-old man. This is the first report, to our knowledge, of a tracheal cavernous hemangioma that presented with massive hemoptysis. The lesion was removed with a CO2 laser under rigid laryngoscopy. Endovascular tumors, such as tracheobronchial hemangiomas, should be considered a diagnostic option in cases of massive hemoptysis without a significant underlying lung lesion.
Subject(s)
Adult , Aged , Humans , Hemangioma , Hemangioma, Cavernous , Hemoptysis , Laryngoscopy , Lasers, Gas , Lung , TracheaABSTRACT
Here, we report a case of pulmonary paragonimiasis that was improved with initial anti-tuberculosis (TB) therapy but confused with reactivated pulmonary TB. A 53-year-old Chinese female presented with a persistent productive cough with foul smelling phlegm and blood streaked sputum. Radiologic findings showed subpleural cavitary consolidation in the right upper lobe (RUL). Bronchoscopic and cytological examination showed no remarkable medical feature. She was diagnosed with smear-negative TB, and her radiologic findings improved after receiving a 6-month anti-TB therapy. The chest CT scans, however, obtained at 4 months after completion of anti-TB therapy showed a newly developed subpleural consolidation in the RUL. She refused pathologic confirmation and was re-treated with anti-TB medication. Nevertheless, her chest CT scans revealed newly developed cavitary nodules at 5 months after re-treatment. She underwent thoracoscopic wedge resection; the pathological examination reported that granuloma caused by Paragonimus westermani. Paragonimiasis should also be considered in patients assessed with smear-negative pulmonary TB.
Subject(s)
Female , Humans , Middle Aged , Asian People , Cough , Delayed Diagnosis , Granuloma , Paragonimiasis , Paragonimus westermani , Smell , Sputum , Tomography, X-Ray Computed , TuberculosisABSTRACT
BACKGROUND: We aimed to investigate the role of the physician in practice and the factors that influence the success rate of smoking cessation. METHODS: This study retrospectively analyzed 126 adult smokers who had visited the outpatient department of pulmonology, and received motivational interviewing with or without supplement drugs. The findings include continuous smoking abstinence rate, which was evaluated at 6, 12 and 24 weeks, and the factors associated with continuous abstinence for 6 months or longer. RESULTS: The patients with only motivational interviewing accounted for 57.9%, while the nicotine patch therapy was applied to 30.2%; and varenicline was prescribed to 11.9%. The smoking cessation success rates of at 6, 12, and 24 weeks were 55.6%, 47.6%, and 33.3%, respectively. However, even in the failure group at six months, tobacco consumption was decreased under 10 cigarettes per day in 42.1% (53/126). In multivariate logistic regression analysis, degree of Fagerstom Test for Nicotine Dependence (p=0.034; odds ratio, 3.607; 95% confidence interval [CI], 1.102-1.807), the absence of smoking-related lung disease (p=0.008; odds ratio, 4.693; 95% CI, 1.497-14.707), and education level (p=0.001; odds ratio, 181.420; 95% CI, 8.414-3,911.502) were the predictors of successful smoking cessation. CONCLUSION: An improved continuous smoking abstinence rate can be obtained by motivational interviewing, regardless of the association with pharmacotherapy.
Subject(s)
Adult , Humans , Drug Therapy , Education , Logistic Models , Lung Diseases , Motivational Interviewing , Odds Ratio , Outpatients , Pulmonary Medicine , Retrospective Studies , Smoke , Smoking , Smoking Cessation , Tobacco Products , Tobacco Use , Tobacco Use Cessation Devices , Tobacco Use Disorder , VareniclineABSTRACT
Vocal cord dysfunction is characterized by the paradoxical adduction of the vocal cord during inspiration, causing relapsing wheezing or stridor, chest tightness, shortness of breath, and coughing. If the patient exhibiting symptoms of asthma is not responsive to treatment, there is a need to test whether vocal cord dysfunction is complicated by asthma. Herein, we report a case of vocal cord dysfunction with acute respiratory failure in old age with underlying disease. The patient presented with resting dyspnea, an audible wheeze, and was first diagnosed with acute exacerbation of bronchial asthma. However, her symptoms were not controlled with medical treatment and laryngoscopy showed paradoxical adduction of the vocal cords. Sudden cardiopulmonary arrest occurred after meal on the day of laryngoscopic examination. Although successful cardiopulmonary resuscitation, the patient developed ventilator-associated pneumonia, and multiple organ failure, eventually leading to death. Because the case was fatal, a report is being issued.
Subject(s)
Humans , Asthma , Cardiopulmonary Resuscitation , Cough , Dyspnea , Heart Arrest , Laryngoscopy , Meals , Multiple Organ Failure , Pneumonia, Ventilator-Associated , Respiratory Insufficiency , Respiratory Sounds , Thorax , Vocal CordsABSTRACT
BACKGROUND: The sensitivities and specificities of interferon-gamma release assays (IGRAs) vary among different population studies, and the data on the routine use of IGRAs are limited. The aim of this study was to evaluate the role of QuantiFERON-TB Gold In-Tube (QFT-GIT) test in the diagnosis of active tuberculosis. METHODS: We conducted a prospective study, enrolling 77 patients with suspected pulmonary tuberculosis (TB), at a secondary care teaching hospital in Seoul. RESULTS: In total, 12 (15.6%) patients showed indeterminate results due to positive control failure on the QFT-GIT test. Indeterminate results were significantly associated with the elderly, history of the intensive care unit stay, lymphocytopenia, especially low CD4 count, increased C-reactive protein and decreased protein levels. Of the 77 patients, 44 (57.1%) were diagnosed with active pulmonary tuberculosis, and the percentage of false negative results of the QFT-GIT was 36.4% (vs. 31.8% with TST). In the TB group with >65 years old (n=12), the proportions of the indeterminate (33.3% vs. 3.1%) and the false negative results (58.3% vs. 25.0%) of the QFT-GIT were significantly higher than in the younger TB group (n=32). CONCLUSION: Indeterminate and false negative results of QFT-GIT test were not infrequent in tuberculosis, especially in the elderly. Care should be considered for the interpretation with the elderly, immunocompromised, chronic and severely diseased patients.
Subject(s)
Aged , Humans , C-Reactive Protein , CD4 Lymphocyte Count , Hospitals, Teaching , Intensive Care Units , Interferon-gamma Release Tests , Lymphopenia , Prospective Studies , Secondary Care , Tuberculin Test , Tuberculosis , Tuberculosis, PulmonaryABSTRACT
Within the vertebrate nervous system, myelination is required for the normal function of neurons by facilitating the rapid conduction of action potentials along axons. Oligodendrocytes are glial cells which myelinate axons in the central nervous system. Disruption of myelination and remyelination failure can cause human diseases such as multiple sclerosis. Despite the importance of myelination, the molecular basis of oligodendrocyte differentiation and myelination are still poorly understood. To understand the molecular mechanisms which regulate oligodendrocyte differentiation and myelination, novel genes were identified using a microarray analysis. The analysis used oligodendrocyte lineage cells isolated from transgenic zebrafish expressing fluorescent proteins in the oligodendrocyte lineage cells. Seven genes not previously known to be involved in oligodendrocyte differentiation were identified, and their expression during oligodendrocyte development was validated.