Benign Cephalic Histiocytosis in a Patient with Neurofibromatosis Type 1 / 대한피부과학회지

Benign cephalic histiocytosis (BCH) is an uncommon subtype of non-Langerhans cell histiocytosis. A 5-month-old boy presented with multiple yellowish facial papules and plaques, which later spread to his trunk and both extremities. Laboratory tests, including lipid profile, were normal. Histological examination revealed non-foamy histiocytes, lymphocytes, and some eosinophils in the dermis. Immunohistochemical staining was positive for CD68and factor XIIIa, but negative for CD1a and S-100. Additionally, the patient developed multiple café-au-lait spots with axillary and inguinal freckling. Next-generation sequencing identified a pathogenic variant of the neurofibromatosis type 1 (NF1) gene. Herein, we report a rare case of BCH in a patient with NF1. Although many cases of NF1 accompanied by juvenile xanthogranuloma have been reported, the association between BCH and NF1 has not been elucidated. However, considering that BCH may be a clinicopathological variant of juvenile xanthogranuloma, an association between the two diseases can be considered.

Establishment of a Maximum Surgical Blood Order Schedule and Red Blood Cell Mean Transfusion Units Per Patient According to Adjacent Diagnosis Related Groups Patient Classification System

Background@#For effective management of blood components, periodic updates of the maximum surgical blood order schedule (MSBOS) using recent data are crucial. This study aimed to establish an updated MSBOS and red blood cell (RBC) mean transfusion units per patient according to the adjacent diagnosis related groups (ADRG) classification system. @*Methods@#This retrospective study was based on an audit of the medical records of inpatients at a tertiary hospital between January and December 2017. We investigated transfusion-related data to establish the MSBOS and determine the RBC mean transfusion units per patient according to the ADRG and compared these updated values with previous data. @*Results@#During the investigated period, a total of 5,607 RBC units were transfused in 17,382 patients. The revised MSBOS was similar to the previous MSBOS in most surgeries. Among the 130 ADRG codes analyzed, 34 codes showed an increase, while 96 codes showed a decrease in RBC mean transfusion units per patient, compared to data from 2007. Overall, the RBC mean transfusion units per patient in 2017 was 0.89 units less compared to that in 2007 after adjusting for age (95% CI: 0.853–0.912). @*Conclusions@#The revised MSBOS was similar to that of the previous versions. However, there were differences in the number of RBC transfusion units used in some surgeries and disease treatments compared to those in the past. Considering the changes within the medical environment, this study highlights the importance of periodic evaluation of MSBOS and RBC transfusion usage.

Comparison of Clinical Utility between Phadiatop Assay and AdvanSureTM AlloScreen

Background@#Multiple Allergo-Sorbent Test (MAST) allows simultaneous detection of specific IgE antibodies using multiple allergens, and it is commonly used for allergy screening. Phadiatop assay (Phadia AB, Sweden), including Phadiatop test and Phadiatop Infant test, is a variant of specific IgE test that covers a mixture of common allergens. We compared the clinical utility of Phadiatop assay with that of the MAST AlloScreen (LG Life Science, Korea). @*Methods@#A total of 218 samples classified by AlloScreen results were collected. Phadiatop test was performed on sera from 61 and 103 aeroallergen-positive and -negative subjects. Phadiatop Infant test was performed on sera from 54 and 103 food and aeroallergen-positive and -negative subjects. When the results of AlloScreen and Phadiatop assay were not identical, we confirmed them using ImmunoCAP (Phadia AB). @*Results@#The concordance rate between AlloScreen and Phadiatop test was 93.2% (κ=0.86, P<0.001). Eleven (6.7%) of 164 specimens showed discrepant results. The results of AlloScreen did not agree with those of ImmunoCAP. The concordance rate between AlloScreen and Phadiatop Infant test was 97.4% (κ=0.945, P <0.001). Four (2.5%) specimens showed negative results in AlloScreen and positive results in Phadiatop Infant test. Three cases were confirmed as positive and one case was not confirmed through ImmunoCAP. @*Conclusions@#There was excellent agreement between AlloScreen and Phadiatop assay. Phadiatop assay accurately detected sensitization to common food and aeroallergen mixes. Therefore, Phadiatop assay is recommended as a screening test for allergic diseases.

Comparison of Clinical Utility between Phadiatop Assay and AdvanSureTM AlloScreen

Background@#Multiple Allergo-Sorbent Test (MAST) allows simultaneous detection of specific IgE antibodies using multiple allergens, and it is commonly used for allergy screening. Phadiatop assay (Phadia AB, Sweden), including Phadiatop test and Phadiatop Infant test, is a variant of specific IgE test that covers a mixture of common allergens. We compared the clinical utility of Phadiatop assay with that of the MAST AlloScreen (LG Life Science, Korea). @*Methods@#A total of 218 samples classified by AlloScreen results were collected. Phadiatop test was performed on sera from 61 and 103 aeroallergen-positive and -negative subjects. Phadiatop Infant test was performed on sera from 54 and 103 food and aeroallergen-positive and -negative subjects. When the results of AlloScreen and Phadiatop assay were not identical, we confirmed them using ImmunoCAP (Phadia AB). @*Results@#The concordance rate between AlloScreen and Phadiatop test was 93.2% (κ=0.86, P<0.001). Eleven (6.7%) of 164 specimens showed discrepant results. The results of AlloScreen did not agree with those of ImmunoCAP. The concordance rate between AlloScreen and Phadiatop Infant test was 97.4% (κ=0.945, P <0.001). Four (2.5%) specimens showed negative results in AlloScreen and positive results in Phadiatop Infant test. Three cases were confirmed as positive and one case was not confirmed through ImmunoCAP. @*Conclusions@#There was excellent agreement between AlloScreen and Phadiatop assay. Phadiatop assay accurately detected sensitization to common food and aeroallergen mixes. Therefore, Phadiatop assay is recommended as a screening test for allergic diseases.

Serotype Distribution and Antimicrobial Resistance of Invasive and Noninvasive Streptococcus pneumoniae Isolates in Korea between 2014 and 2016

BACKGROUND: Several factors contribute to differences in Streptococcus pneumoniae serotype distribution. We investigated the serotype distribution and antimicrobial resistance of S. pneumoniae isolated between 2014 and 2016 in Korea. METHODS: We collected a total of 1,855 S. pneumoniae isolates from 44 hospitals between May 2014 and May 2016, and analyzed the serotypes by sequential multiplex PCR. We investigated the distribution of each serotype by patient age, source of the clinical specimen, and antimicrobial resistance pattern. RESULTS: The most common serotypes were 11A (10.1%), followed by 19A (8.8%), 3 (8.5%), 34 (8.1%), 23A (7.3%), and 35B (6.2%). The major invasive serotypes were 3 (12.6%), 19A (7.8%), 34 (7.8%), 10A (6.8%), and 11A (6.8%). Serotypes 10A, 15B, 19A, and 12F were more common in patients ≤5 years old, while serotype 3 was more common in patients ≥65 years old compared with the other age groups. The coverage rates of pneumococcal conjugate vaccine (PCV)7, PCV10, PCV13, and pneumococcal polysaccharide vaccine 23 were 11.8%, 12.12%, 33.3%, and 53.6%, respectively. Of the 1,855 isolates, 857 (46.2%) were multi-drug resistant (MDR), with serotypes 11A and 19A predominant among the MDR strains. The resistance rates against penicillin, cefotaxime, and levofloxacin were 22.8%, 12.5%, and 9.4%, respectively. CONCLUSIONS: There were significant changes in the major S. pneumoniae serotypes in the community. Non-PCV13 serotypes increased in patients ≤5 years old following the introduction of national immunization programs with the 10- and 13-polyvalent vaccines.

Trends in Bloodstream Infections and Antimicrobial Susceptibilities at a University Hospital in Korea Between 2007 and 2016

BACKGROUND: Blood culture is an important method for identifying infectious microorganisms and confirming that a selected antimicrobial treatment is appropriate. In this study, we investigated the annual changes in the frequencies of blood isolates and antibiotic susceptibility test (AST) results. METHODS: We created a large database comprising data on all patient-unique blood cultures obtained from January 2007 through December 2016. Blood specimens were cultured using the BD BACTEC FX system, and species identification and AST were performed using the VITEK 2 system. RESULTS: During the 10-year study period, a total of 203,651 blood culture results were collected. Of these, gram-positive cocci, gram-negative rods, and fungi were isolated in 2.15%, 0.55%, and 0.12% of the blood cultures, respectively. Escherichia coli was the most commonly isolated species (22.8%), followed by Staphylococcus epidermidis (16.8%), Klebsiella pneumoniae (8.1%), and Staphylococcus aureus (8.0%). Fungal species were isolated in 3.0% of all positive blood cultures. Candida albicans was the most commonly isolated species (1.1%), followed by Candida parapsilosis (0.6%). Methicillin resistance was seen in 55.2% of S. aureus isolates. The frequencies of vancomycin-resistant Enterococcus (VRE) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) were 13.1% and 10.9%, respectively. The isolation rates of MRSA, VRE, and CRPA showed different patterns each year. CONCLUSIONS: Among the isolates, E. coli was the most common, followed by S. epidermidis and K. pneumoniae. This study represents a long-term analysis of bloodstream infections, and the results can be used to identify trends in the microorganisms isolated and their drug resistance.

Evaluation of adjacent tooth displacement in the posterior implant restoration with proximal contact loss by superimposition of digital models

PURPOSE: This study was conducted to investigate patterns of adjacent tooth displacement in the posterior implant with interproximal contact loss (ICL) by 3-D digital superimposition method. MATERIALS AND METHODS: Posterior partially edentulous patients, restored with implant fixed partial prostheses before 2011 and suffered from food impaction of ICL between 2009 and 2011, were included. Two dental casts, at the time of delivery and at the time of food impaction in a same patient, was converted into 3-D digital models through scanning and superimposition was performed to assess chronologic changes of the dentition. Directions of tooth displacement were evaluated and the amount of ICL was calculated. Correlations between the amount of ICL and elapsed time, or between the amount of ICL and age after function, were assessed at a significance level of P.05). CONCLUSION: Natural teeth showed various directional movements to result in occlusal change in the arch. The 3-D superimposition of chronologic digital models was a helpful method to analyze the changes of dentition and individual tooth displacement adjacent to implant restoration.

Occupational Accident Experience by Working Life Cycle of Korean Workers / 한국직업건강간호학회지

PURPOSE@#In this study, we attempted to analyze the occupational accident experience rate by working life cycle of Korean workers considering entrance and turnover in their jobs. The specific goal of this study was to calculate the accident experience rate according to workers' turnover history and previous accident experience.@*METHODS@#We constructed a cumulative data set of 90,338 cases of workers' accident experiences in their jobs from the Fourth Korean Working Conditions Survey. The accident experience rates according to workers' turnover and previous accident experiences were analyzed using descriptive statistics and analysis of variance.@*RESULTS@#In this study, the cumulative accident experience rate of Korean workers was found to be 5.2%. It was confirmed that the accident experience rate of workers increased as the turnover frequencies increased. In addition, we analyzed only the data of the workers who had experienced turnover and found that the accident experience rate after turnover increased about 7.5 times when workers had experienced accidents in the past.@*CONCLUSION@#To prevent occupational accidents in workers, safety strategies should consider a worker's previous job history and injury experiences. It will also be necessary to focus preventive efforts on new and young workers through ongoing monitoring and on-the-job training.

Central Regulation of Micturition and Its Association With Epilepsy / 대한배뇨장애요실금학회지

Micturition is a complex process involving the bladder, spinal cord, and the brain. Highly sophisticated central neural program controls bladder function by utilizing multiple brain regions, including pons and suprapontine structures. Periaqueductal grey, insula, anterior cingulate cortex, and medial prefrontal cortex are components of suprapontine micturition centers. Under pathologic conditions such as epilepsy, urinary dysfunction is a frequent symptom and it seems to be associated with increased suprapontine cortical activity. Interestingly, micturition can also trigger seizures known as reflex epilepsy. During voiding behavior, frontotemporal cortical activation has been reported and it may induce reflex seizures. As current researches are only limited to present clinical cases, more rigorous investigations are needed to elucidate biological mechanisms of micturition to advance our knowledge on the process of micturition in physiology and pathology.

The Relationship between Plasma Oxytocin Levels and Social Anxiety Symptoms

OBJECTIVE: The pathophysiology of social anxiety disorder (SAD) is not yet well understood, but previous research has suggested that oxytocin is associated with social behavior and may play a role in human anxiety states and anxiety-related traits. The aim of this study was to investigate the possible relationship between social anxiety symptoms and plasma oxytocin levels. METHODS: Twenty-three male patients with SAD and 28 healthy male controls participated in this study. All participants were assessed using the Mini International Neuropsychiatric Interview (MINI) and the Liebowitz Social Anxiety Scale (LSAS). Multivariate regression analysis was performed to identify associations between plasma oxytocin levels and SAD. RESULTS: In multiple regression models, after controlling for age and years of education, we found that higher oxytocin levels were significantly associated with higher total LSAS scores (R²=0.157, coefficient=0.145, 95% CI=-0.0005–0.291, p=0.051) and fear subscale scores (R²=0.134, coefficient=0.083, 95% CI=0.007–0.159, p=0.034) in the SAD group. CONCLUSION: In this study, increased plasma oxytocin levels were associated with higher social anxiety symptoms among SAD patients, but not among controls. This might be because among SAD patients, higher oxytocin (OT) secretion is an insufficient compensatory attempt to reduce social anxiety symptoms.

Occupational Accident Experience by Working Life Cycle of Korean Workers / 산업간호학회지

PURPOSE: In this study, we attempted to analyze the occupational accident experience rate by working life cycle of Korean workers considering entrance and turnover in their jobs. The specific goal of this study was to calculate the accident experience rate according to workers' turnover history and previous accident experience. METHODS: We constructed a cumulative data set of 90,338 cases of workers' accident experiences in their jobs from the Fourth Korean Working Conditions Survey. The accident experience rates according to workers' turnover and previous accident experiences were analyzed using descriptive statistics and analysis of variance. RESULTS: In this study, the cumulative accident experience rate of Korean workers was found to be 5.2%. It was confirmed that the accident experience rate of workers increased as the turnover frequencies increased. In addition, we analyzed only the data of the workers who had experienced turnover and found that the accident experience rate after turnover increased about 7.5 times when workers had experienced accidents in the past. CONCLUSION: To prevent occupational accidents in workers, safety strategies should consider a worker's previous job history and injury experiences. It will also be necessary to focus preventive efforts on new and young workers through ongoing monitoring and on-the-job training.

Mutation Analysis of X-linked Sideroblastic Anemia in a 12-Month-Old Boy by Massively Parallel Sequencing

No abstract available.

First Case of Psychrobacter sanguinis Bacteremia in a Korean Patient / 대한임상미생물학회지

Psychrobacter sanguinis has been described as a Gram-negative, aerobic coccobacilli originally isolated from environments and seaweed samples. To date, 6 cases of P. sanguinis infection have been reported. A 53-year-old male was admitted with a generalized tonic seizure lasting for 1 minute with loss of consciousness and a mild fever of 37.8℃. A Gram stain revealed Gram-negative, small, and coccobacilli-shaped bacteria on blood culture. Automated microbiology analyzer identification using the BD BACTEC FX (BD Diagnostics, Germany) and VITEK2 (bioMérieux, France) systems indicated the presence of Methylobacterium spp., Aeromonas salmonicida, and the Moraxella group with low discrimination. The GenBank Basic Local Alignment Search Tool and an Ez-Taxon database search revealed that the 16S rRNA gene sequence of the isolate showed 99.30% and 99.88% homology to 859 base-pairs of the corresponding sequences of P. sanguinis, respectively (GenBank accession numbers JX501674.1 and HM212667.1). To the best of our knowledge, this is the first human case of P. sanguinis bacteremia in Korea. It is notable that we identified a case based on blood specimens that previously had been misidentified by a commercially automated identification analyzer. We utilized 16S rRNA gene sequencing as a secondary method for correctly identifying this microorganism.

Evaluation of Cobas b 101 HbA1c Analyzer Performance for Point-of-Care Testing

BACKGROUND: The use of point-of-care (POC) devices for evaluating HbA1c is increasing; accordingly, comparisons between these devices and central laboratory methods are important. In the present study, we evaluated the analytical performance of the cobas b 101 analyzer for POC HbA1c testing. METHODS: The analytical quality of the cobas b 101 system was assessed based on repeatability, within-laboratory precision, linearity, and lot-to-lot reproducibility. Two specimen types, i.e., EDTA whole blood and capillary blood, were examined using the cobas b 101 system and the Variant II Turbo instrument. RESULTS: The coefficient of variation for within laboratory precision was 5.22% for a normal HbA1c level and 2.56% for a higher HbA1c level. The method showed good linearity, with a coefficient of correlation of 0.990. In a comparison of two different HbA1c disk lots, a strong correlation (r=0.986) and a mean %difference of −2.9% were observed. The cobas b 101 results using EDTA whole blood were strongly correlated with the Variant II Turbo results (r=0.958), with a mean %difference of 0.8%; the cobas b 101 results using capillary blood were strongly correlated with the Variant II Turbo results, using EDTA whole blood (r=0.976), with a mean %difference of 2.0%. A comparison between HbA1c levels in EDTA whole blood and capillary blood obtained using the cobas b 101 showed a strong correlation (r=0.985) and a mean %difference of 1.3%. CONCLUSIONS: The cobas b 101 analyzer is convenient for the measurement of HbA1c levels for diabetes management.

Robinsoniella peoriensis Bacteremia: a Second Case in Korea

No abstract available.

Robinsoniella peoriensis Bacteremia: a Second Case in Korea

No abstract available.

Comparison of the efficacy of disinfectants in automated endoscope reprocessors for colonoscopes: tertiary amine compound (Sencron2®) versus ortho-phthalaldehyde (Cidex®OPA)

BACKGROUND/AIMS: To prevent the transmission of pathogens by endoscopes, following established reprocessing guidelines is critical. An ideal reprocessing step is simple, fast, and inexpensive. Here, we evaluated and compared the efficacy and safety of two disinfectants, a tertiary amine compound (TAC) and ortho-phthalaldehyde (OPA). METHODS: A total of 100 colonoscopes were randomly reprocessed using two same automated endoscope reprocessors, according to disinfectant. The exposure time was 10 minutes for 0.55% OPA (Cidex® OPA, Johnson & Johnson) and 5 minutes for 4% TAC (Sencron2®, Bab Gencel Pharma & Chemical Ind. Co.). Three culture samples were obtained from each colonoscope after reprocessing. RESULTS: A total of nine samples were positive among the 300 culture samples. The positive culture rate was not statistically different between the two groups (4% for OPA and 2% for TAC, P=0.501). There were no incidents related to safety during the study period. CONCLUSIONS: TAC was non-inferior in terms of reprocessing efficacy to OPA and was safe to use. Therefore, TAC seems to be a good alternative disinfectant with a relatively short exposure time and is also less expensive than OPA.

Evaluation of Serum Cotinine Cut-Off to Distinguish Smokers From Nonsmokers in the Korean Population

BACKGROUND: Cotinine has been widely used as an objective marker to identify current smokers. We conducted this study to address the absence of Korean studies investigating the efficacy of immunoassays and liquid chromatography-tandem mass spectrometry (LC-MS/MS) for the detection of serum cotinine and to determine the optimal serum cotinine cut-off level for differentiating current smokers from nonsmokers. METHODS: Serum specimens were obtained from 120 subjects. They were randomly chosen to represent a broad distribution of urine cotinine levels based on a retrospective review of questionnaires and results of urine cotinine levels. We determined serum cotinine levels using the IMMULITE 2000 XPi Immunoassay System (Siemens Healthcare Diagnostics Inc., USA) and LC-MS/MS (API-4000, Applied Biosystems, USA). Correlation was analyzed between IMMULITE serum cotinine, urine cotinine, and LC-MS/MS serum cotinine levels. ROC curve was analyzed to identify the optimal IMMULITE serum cotinine cut-off level for differentiating current smokers from nonsmokers. RESULTS: IMMULITE serum cotinine levels correlated with both urine cotinine and LC-MS/MS serum cotinine levels, with correlation coefficients of 0.958 and 0.986, respectively. The optimal serum cotinine cut-off level for distinguishing current smokers from nonsmokers was 13.2 ng/mL (95.7% sensitivity, 94.1% specificity) using IMMULITE. CONCLUSIONS: This is the first study to investigate the use of LC-MS/MS for the measurement of serum cotinine and to determine the optimal serum cotinine cut-off level for the IMMULITE immunoassay. Our results could provide guidelines for differentiating current smokers from nonsmokers in the Korean population.

A female adnexal tumor of probable Wolffian origin showing positive O-6-methylguanine-DNA methyltransferase methylation

Female adnexal tumor of probable Wolffian origin (FATWO) is a rare disease entity that arises from the mesonephric duct system. FATWO is different than other gynecological cancers in terms of embryology. Here, we describe the case of a 52-year-old woman with malignant FATWO. The patient underwent explorative laparotomy and surgical staging after a frozen section revealed malignancy. Detailed examination of the pathologic findings were consistent with FATWO. Counseling and further testing were provided to the patient to assess the risk of germline mutation and epigenetic change. An O-6-methylguanine-DNA methyltransferase gene methylation test was positive, and all other tests were normal. This is the first study to report a case of O-6-methylguanine-DNA methyltransferase methylation with FATWO in Korea.

A Case of Hepatocellular Carcinoma Presenting as a Gingival Mass / 대한소화기학회지

Oral metastatic tumor, which is uncommon and represents less than 1% of malignant oral neoplasms, usually arises from a primary mucosal or cutaneous cancer located in the head and neck regions. Metastasis of hepatocellular carcinoma (HCC) to the oral cavity, especially to gingiva, is extremely rare. A 50-year-old man, who was a chronic alcoholic and hepatitis B virus carrier, presented with abdominal distension and weight loss for the past 3 months. Three-phased contrast-enhanced abdominal CT revealed numerous conglomerated masses in the liver, suggesting huge HCCs arising in the background of liver cirrhosis with a large amount of ascites. He complained of recurrent profuse bleeding from the left upper gingival mass. A facial CT revealed an oral cavity mass destructing the left maxillary alveolar process and hard palate, which was diagnosed as metastatic HCC by an incisional biopsy. Herein, we report a case of metastatic HCC to the gingiva.