Effectiveness and Usefulness of Bone Turnover Marker in Osteoporosis Patients: A Multicenter Study in Korea

Background@#This study aimed to investigate real-world data of C-terminal telopeptide (CTX), propeptide of type I collagen (P1NP), and osteocalcin through present multicenter clinical study, and retrospectively analyze the usefulness of bone turnover markers (BTMs) in Koreans. @*Methods@#The study focused on pre- and post-menopausal patients diagnosed with osteoporosis and excluded patients without certain test results or with test intervals of over 1 year. The demographic data and 3 BTMs (CTX, P1NP, and osteocalcin) were collected. The patients were classified by demographic characteristics and the BTM concentrations were analyzed by the group. @*Results@#Among women with no history of fractures, the levels of P1NP (N=2,100) were 43.544±36.902, CTX (N=1,855) were 0.373 ±0.927, and osteocalcin (N=219) were 10.81 ±20.631. Among men with no history of fractures, the levels of P1NP (N=221) were 48.498±52.892, CTX (N=201) were 0.370±0.351, and osteocalcin (N=15) were 7.868 ±10.674. Treatment with teriparatide increased the P1NP levels after 3 months in both men and women, with a 50% increase observed in women. Similarly, treatment with denosumab decreased the CTX levels after 3 months in both men and women, with a reduction of 50% observed in women. @*Conclusions@#The results of this study can contribute to the accurate assessment of bone replacement status in Koreans. We also provide the P1NP level in the Korean population for future comparative studies with other populations.

Effect of Artificial Intelligence or Machine Learning on Prediction of Hip Fracture Risk: Systematic Review

Background@#Dual energy X-ray absorptiometry (DXA) is a preferred modality for screening or diagnosis of osteoporosis and can predict the risk of hip fracture. However, the DXA test is difficult to implement easily in some developing countries, and fractures have been observed before patients underwent DXA. The purpose of this systematic review is to search for studies that predict the risk of hip fracture using artificial intelligence (AI) or machine learning, organize the results of each study, and analyze the usefulness of this technology. @*Methods@#The PubMed, OVID Medline, Cochrane Collaboration Library, Web of Science, EMBASE, and AHRQ databases were searched including “hip fractures” AND “artificial intelligence”. @*Results@#A total of 7 studies are included in this study. The total number of subjects included in the 7 studies was 330,099. There were 3 studies that included only women, and 4 studies included both men and women. One study conducted AI training after 1:1 matching between fractured and non-fractured patients. The area under the curve of AI prediction model for hip fracture risk was 0.39 to 0.96. The accuracy of AI prediction model for hip fracture risk was 70.26% to 90%. @*Conclusions@#We believe that predicting the risk of hip fracture by the AI model will help select patients with high fracture risk among osteoporosis patients. However, to apply the AI model to the prediction of hip fracture risk in clinical situations, it is necessary to identify the characteristics of the dataset and AI model and use it after performing appropriate validation.

Osteoporosis Feature Selection and Risk Prediction Model by Machine Learning Using a Cross-Sectional Database

Background@#The purpose of this study was to verify the accuracy and validity of using machine learning (ML) to select risk factors, to discriminate differences in feature selection by ML between men and women, and to develop predictive models for patients with osteoporosis in a big database. @*Methods@#The data on 968 observed features from a total of 3,484 the Korea National Health and Nutrition Examination Survey participants were collected. To find preliminary features that were well-related to osteoporosis, logistic regression, random forest, gradient boosting, adaptive boosting, and support vector machine were used. @*Results@#In osteoporosis feature selection by 5 ML models in this study, the most selected variables as risk factors in men and women were body mass index, monthly alcohol consumption, and dietary surveys. However, differences between men and women in osteoporosis feature selection by ML models were age, smoking, and blood glucose level. The receiver operating characteristic (ROC) analysis revealed that the area under the ROC curve for each ML model was not significantly different for either gender. @*Conclusions@#ML performed a feature selection of osteoporosis, considering hidden differences between men and women. The present study considers the preprocessing of input data and the feature selection process as well as the ML technique to be important factors for the accuracy of the osteoporosis prediction model.

Effectiveness of Weekly Teriparatide Injection in Postmenopausal Patients with Hip Fractures

Background@#Teriparatide is an effective anabolic agent used in the treatment of severe osteoporosis. In addition, it is also used to promote fracture healing. The purpose of this double-blind randomized controlled trial was to evaluate the influence of weekly teriparatide administration on bone formation in hip fracture patients. @*Methods@#The control group (n = 41) was composed of patients treated with normal saline other than teriparatide, and the teriparatide group (n = 51) consisted of patients who received weekly teriparatide. Bone turnover markers, C-terminal telopeptide (CTx) and osteocalcin (OC), were assessed through blood tests at the initial hospital visit and 3-month, 6-month, and 1-year follow-ups. Dual-energy X-ray absorptiometry was performed 5 days postoperatively and at 1-year postoperative follow-up. The degree of fracture union was evaluated by comparing the radiographic union scoring system for hips using Radiographic Union Score for Hip (RUSH) scores between the two groups at 3 months, 6 months, and 1 year after surgery. @*Results@#Evaluation of the rate of change in bone mineral density over 1 year showed that the lumber bone mineral density increased by more than 7% in the experimental group. The control group did not show a difference between the CTx and OC at 6 months, but the difference between the CTx and OC values was large at 6 months in the experimental group. The mean RUSH score was significantly different between the control group and the experimental group: 12.105 and 15.476, respectively (p = 0.004), at 3 months and 18.571 and 22.389, respectively, at 6 months (p = 0.006). @*Conclusions@#Weekly use of teriparatide improved fracture healing, bone formation, and clinical outcomes at 1 year after hip fracture surgery by the anabolic window effect.

Pigmented Villonodular Synovitis Developing in the Knee of a Rheumatoid Arthritis Patient Mistaken as a Rheumatoid Arthritis Flare-Up / 대한내과학회지

Pigmented villonodular synovitis is a benign tumor arising from synovial fibroblasts or histiocytes. There are diffuse and localized forms: the former involves the entire synovium and the latter consists of nodules, small tumefactions, or pedunculated masses. The knee is the joint most commonly affected and the clinical diagnosis is difficult, so initial misdiagnosis is common. We report a case of pigmented villonodular synovitis developing in the knee of rheumatoid arthritis (RA) patient, mistaken for an RA flare-up.

Pigmented Villonodular Synovitis Developing in the Knee of a Rheumatoid Arthritis Patient Mistaken as a Rheumatoid Arthritis Flare-Up / 대한내과학회지

Pigmented villonodular synovitis is a benign tumor arising from synovial fibroblasts or histiocytes. There are diffuse and localized forms: the former involves the entire synovium and the latter consists of nodules, small tumefactions, or pedunculated masses. The knee is the joint most commonly affected and the clinical diagnosis is difficult, so initial misdiagnosis is common. We report a case of pigmented villonodular synovitis developing in the knee of rheumatoid arthritis (RA) patient, mistaken for an RA flare-up.

Comparison of Interferon-gamma Secretion by Stimulated NK Cells and T cells from Healthy Subjects

Interferon-γ (IFN-γ) is an important cytokine produced by natural killer (NK) cells and T cells in response to various stimuli. The levels of IFN-γ secreted after stimulation of NK cells using a recombinant cytokine is represented as one of functions of NK cells. Recently, a method for evaluating NK cell activity in whole blood samples was developed. The levels of IFN-γ secreted after NK cell stimulation with PROMOCA™ (ATGen, Korea) and T cell stimulation with phytohemagglutinin (PHA) were compared using two different commercial kits: NK Vue Gold (ATGen, Korea) and QuantiFERON-TB Gold In-Tube (Cellestis, Australia). Participants included 43 healthy individuals. Whole blood samples were incubated with either PROMOCA, a recombinant cytokine that specifically activates NK cells, or with PHA. IFN-γ levels in the supernatants were measured by ELISA. The level of IFN-γ by PROMOCA stimulation (PROMOCA IFN-γ) was more varied than that by stimulation with PHA (PHA IFN-γ) (median 1,544.4 pg/mL [ range 193.7–2,530.9] vs. median 2,470.1 pg/mL [ 2,250.1–2,874.4] P=0.0001). The median of PHA IFN-γ/PROMOCA IFN-γ ratio was 1.9 (1.1–12.4). There was a significant difference in levels of IFN-γ secreted after stimulation with PROMOCA or PHA in the healthy population.

Control Efficacy of Streptomyces sp. A501 against Ginseng Damping-off and Its Antifungal Substance

Ginseng damping-off, caused by the fungal pathogens Rhizoctonia solani and Pythium sp., is a critical disease in ginseng seedling. In a continuing effort to find microorganisms with the potential of acting as a biocontrol agent against Rhizoctonia damping-off, we found that a Streptomyces sp. A501 showed significant antifungal activity against Rhizoctonia solani. In field experiment to test the efficacy of Streptomyces sp. A501 in controlling ginseng damping-off, the incidence of damping-off disease was meaningfully reduced when ginseng seeds were soaked in the culture broth of Streptomyces sp. A501 before sowing. To perform characterization of the antifungal compound, we isolated it from the culture broth of strain A501 through Diaion HP-20 and silica gel column chromatographies and preparative high-performance liquid chromatography. The structure of the antifungal compound was assigned as fungichromin by spectroscopic methods, mainly nuclear magnetic resonance and electrospray ionization-mass analysis.

An Atypical Case of Peripheral T Cell Lymphoma with Hemolytic Anemia and Thrombocytopenia/Neutropenia Mimicking Systemic Lupus Erythematous / 대한내과학회지

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects various organs, so it is easily confused with other diseases and thus misdiagnosed. SLE is defined only by classification criteria and not by diagnostic criteria, so other diseases must be excluded before SLE can be diagnosed. We report a case of peripheral T cell lymphoma that mimicked SLE initially.

Correlation of Cardiothoracic Ratio and Right Ventricular Systolic Pressure in Systemic Sclerosis

OBJECTIVE: This study was designed to assess sequential association between right ventricular systolic pressure and cardiothoracic (C/T) ratio of chest radiography in systemic sclerosis (SSc) patients and inferred pulmonary arterial hypertension by increased C/T ratio and right ventricular systolic pressure. METHODS: Twenty-eight consecutive patients with confirmed SSc (22 females, 6 males; mean age 51.1+/-2.1 years), with a mean time of 91.0+/-6.7 months from SSc diagnosis, were prospectively included in the study. C/T ratio was obtained by chest radiography with an interval of two years. The first C/T ratio was taken at diagnosis and second C/T ratio was taken at the time of enrollment. The enrolled subjects were agree to undergo echocardiography and measurement of brain natriuretic peptide. RESULTS: In 24 SSc patients with normal right ventricular systolic pressure, 10 SSc patients had increased C/T ratio, the other four SSc patients with increased right ventricular systolic pressure by echocardiography, had increased C/T ratio all together. In four SSc patients with increased right ventricular systolic pressure, one patient had resting dyspnea, taken cardiac catheterization and confirmed as pulmonary hypertension and the other three patients had no clinical symptoms. The increased right ventricular systolic pressure is related to the increase of C/T ratio (>0.55) in chest radiography (p0.55) in chest radiography was associated with increased right ventricular systolic pressure measured by echocardiography and inferred a role in early detection of asymptomatic pulmonary arterial hypertension in SSc patients.

A Case of Rituximab Therapy in Diffuse Alveolar Hemorrhage of Systemic Lupus Erythematosus Refractory to Steroid Pulse Therapy

Rituximab is a chimeric murine-human monoclonal antibody that is directed against the specific B-cell CD20 antigen, which has recently been successfully used in active or refractory systemic lupus erythematosus (SLE) manifestations, such as nephritis, thrombocytopenia, and vasculitis. We report a case of a 25-year-old woman diagnosed with diffuse alveolar hemorrhage of SLE refractory to steroid pulse therapy. The patient was treated successfully with rituximab as a part of the immunosuppressive regimen.

Influence of Additives on the Yield and Pathogenicity of Conidia Produced by Solid State Cultivation of an Isaria javanica Isolate

Recently, the Q biotype of tobacco whitefly has been recognized as the most hazardous strain of Bemisia tabaci worldwide, because of its increased resistance to some insecticide groups. As an alternative control agent, we selected an Isaria javanica isolate as a candidate for the development of a mycopesticide against the Q biotype of sweet potato whitefly. To select optimal mass production media for solid-state fermentation, we compared the production yield and virulence of conidia between 2 substrates (barley and brown rice), and we also compared the effects of various additives on conidia production and virulence. Barley was a better substrate for conidia production, producing 3.43 x 10(10) conidia/g, compared with 3.05 x 10(10) conidia/g for brown rice. The addition of 2% CaCO3 + 2% CaSO4 to barley significantly increased conidia production. Addition of yeast extract, casein, or gluten also improved conidia production on barley. Gluten addition (3% and 1.32%) to brown rice improved conidia production by 14 and 6 times, respectively, relative to brown rice without additives. Conidia cultivated on barley produced a mortality rate of 62% in the sweet potato whitefly after 4-day treatment, compared with 53% for conidia cultivated on brown rice. The amendment of solid substrate cultivation with additives changed the virulence of the conidia produced; the median lethal time (LT50) was shorter for conidia produced on barley and brown rice with added yeast extract (1.32% and 3%, respectively), KNO3 (0.6% and 1%), or gluten (1.32% and 3%) compared with conidia produced on substrates without additives.

Virulence of Entomopathogenic Fungi Metarhizium anisopliae and Paecilomyces fumosoroseus for the Microbial Control of Spodoptera exigua

The beet armyworm Spodoptera exigua (Lepidoptera: Noctuidae) is difficult to control using chemical insecticides because of the development of insecticide resistance. Several pest control agents are used to control the beet armyworm. Entomopathogenic fungi are one of the candidates for eco-friendly pest control instead of chemical control agents. In this study, among various entomopathogenic fungal strains isolated from soil two isolates were selected as high virulence pathogens against larva of beet armyworm. Control efficacy of fungal conidia was influenced by conidia concentration, temperature, and relative humidity (RH). The isolates Metarhizium anisopliae FT83 showed 100% cumulative mortality against second instar larvae of S. exigua 3 days after treatment at 1 x 10(7) conidia/mL and Paecilomyces fumosoroseus FG340 caused 100% mortality 6 days after treatment at 1 x 10(4) conidia/mL. Both M. anisopliae FT83 and P. fumosoroseus FG340 effectively controlled the moth at 20~30degrees C. M. anisopliae FT83 was significantly affected mortality by RH: mortality was 86.7% at 85% RH and 13.4% at 45% RH. P. fumosoroseus FG340 showed high mortality as 90% at 45% RH and 100% at 75% RH 6 days after conidia treatments. These results suggest that P. fumosoroseus FG340 and M. anisopliae FT83 have high potential to develop as a biocontrol agent against the beet armyworm.

Pulmonary Cryptococcosis in Rheumatoid Arthritis Patient Treated With Leflunomide

Leflunomide, a disease-modifying antirheumatic drug, is effective for rheumatoid arthritis as monotherapy or combination therapy with methotrexate. The most common adverse effects are diarrhea, dyspepsia, nausea, abdominal pain, oral ulcer, hepatotoxicity, skin rash, hypertension, weight loss, and interstitial lung disease. The occurrence of pulmonary cryptococcosis in leflunomide treatment has not been reported in Korea. A 74-year-old woman was admitted to hospital due to asymptomatic pulmonary nodule. She was diagnosed rheumatoid arthritis and treated with leflunomide 5 months ago due to treatment failure with methotrexate, hydroxychloroquine, and sulfasalazine. Chest radiograph and computed tomography showed solitary pulmonary nodule in her right lower lung. Pulmonary cryptococcosis was confirmed by needle biopsy of lung stained with Gomori methenamine silver and mucicarmine. The lesion was improved after antifungal therapy for 3 months.

A Case of Condyloma Acuminata in a Virgin Systemic Lupus Erythematosus Patient

Anogenital infection with human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. The majority of HPV infections are transient and subclinical, with subsequent clearance by the immune system. However, in some individuals, especially those with impaired immunity, HPV infection may persist and result in condyloma acuminatum, pre-cancerous cervical abnormalities, as well as cervical cancer. Because of the intrinsic immunological aberrations and immunosuppressive treatment, patients with systemic lupus erythematosus (SLE) have higher prevalence of anogenital HPV infection, and SLE itself appears to be a major risk factor for HPV infection. HPV infection is sexually transmitted via genital contact; autogenesis of condyloma acuminatum without sexual contact is rare. In this case, a 27-year old virgin female with SLE was admitted to our clinic, presenting anogenital condyloma acuminata. It report that SLE patient can have a disease of anogenital HPV infection, despite the lack of sexual contact. Therefore, we recommend that patients with SLE have regular gynecological evaluations, in addition to prophylactic HPV vaccinations.

A Case of Sjogren's Syndrome Associated with Neuromyelitis Optica

Neuromyelitis optica (NMO) is an idiopathic inflammatory demyelinating disease, characterized by optic neuritis and myelitis. NMO is a very uncommon and serious neurologic manifestation of Sjogren's syndrome. We report on a 32-year-old female with NMO as central nerve system involvement of Sjogren's syndrome. She had a transverse myelitis ten years ago and did not have symptoms for a long period of time. She visited the emergency center because of worsening weakness of both limbs. She had an appendectomy three days ago before hospitalization. Cervical spinal magnetic resonance imaging showed increased signal intensity in T2-weighted images from the cervical (C2) to the upper thoracic (T4) spinal cord. As serum NMO-IgG was positive, we diagnosed neuromyelitis optica and treated with high dose steroid, but failed. Therefore, we treated with plasmapheresis and the patient was discharged without any neurological deficits.

A Case of Pheochromocytoma Misdiagnosed as Activation of Behcet's Disease / 대한내과학회지

A 30 year-old woman with a history of Behcet's disease was admitted to our clinic because of a paroxysmal attack of palpitations, headache, and ocular pain. Initially, we did not suspect a pheochromocytoma. We evaluated Behcet's disease activity because the cardiovascular and neurological symptoms mimicked those of Behcet's disease. Pheochromocytoma is often overlooked and can be fatal if not recognized and treated appropriately. In the present case, abdominal computerized tomography incidentally revealed a mass confirmed to be a pheochromocytoma in the left adrenal gland, and the tumor was successfully removed. This is the first Korean report of a pheochromocytoma in a patient with Behcet's disease. We suggest that pheochromocytoma should be included in the differential diagnosis of Behcet's disease if a patient presents with cardiovascular or neurological symptoms.

Occurrence of Soybean Sleeping Blight Caused by Septogloeum sojae in Korea

Sleeping blight was observed on soybean plants grown in Yanggu, Suwon and Geumsan from 2005 to 2011. Symptoms developed on stems and pods of affected soybean plants. Five fungal isolates were obtained from the diseased plants and identified as Septogloeum sojae based on their morphological, cultural and molecular characteristics. Pathogenicity of the fungus was confirmed on soybean plants by artificial inoculation. This is the first report of S. sojae causing sleeping blight in soybean plants in Korea.

Leaf Spot and Stem Rot on Wilford Swallowwort Caused by Stemphylium lycopersici in Korea

In June 2012, leaf spot and stem rot were observed on Wilford Swallowwort plants grown in Cheonan, Korea. Three fungal isolates obtained from the diseased leaves and stems were identified as Stemphylium lycopersici, based on morphological, cultural, and molecular characteristics and pathogenicity. This is the first report of leaf spot and stem rot on Wilford Swallowwort caused by S. lycopersici.

A Cases of Adult Onset Still's Disease with Hemolytic Anemia

Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology. AOSD is characterized by fever, arthralgia, salmon-colored skin rash, hepatosplenomegaly and its laboratory abnormalities include leukocytosis, elevated liver enzyme, negative autoantibody, and hyperferritinemia. The clinical course varied and severe complicated conditions, such as hemophagocytic syndrome, and disseminated intravascular coagulation, occurred occasionally. Such a complication is accompanied with hemolytic anemia and lead to be a fatal course. We report the first case of AOSD with hemolytic anemia, which improved with high dose steroid therapy.