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1.
Clin Biochem ; 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32007438

RESUMO

Breast cancer is the leading cause of cancer-related mortality worldwide, with a higher incidence in developed countries. The biomarkers for breast cancer such as estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, CA (cancer antigen) 15-3, CA 27.29, and carcinoembryonic antigen have been recommended for use in the laboratory based on the guidelines of American and European societies. Immunoassays have been frequently and consistently used to detect these clinically established biomarkers of breast cancer. Despite the higher accessibility of serum biomarkers, including CA 15-3, CA 27.29, and CEA, compared to tissue markers, variations in immunoassays affect their standardization and clinical utility. When reviewing the immunoassays used to detect these serum markers, we found that the most frequently used immunoassay was enzyme-linked immunosorbent assay, followed by electrochemiluminescent immunoassay, and then chemiluminescence immunoassay for CA 15-3 and CEA. Meanwhile, the chemiluminescence immunoassay was the most common technique for CA27.29. The electrochemiluminescent immunoassay and monoclonal fluorometric assay have become the preferred methods in 2010-2019 compared to 2000-2009. Analytical and clinical performance factors such as sensitivity, specificity, detection limit, hazard risk to laboratory personnel, speed, and economic feasibility influenced these changes in user preference. When using the immunoassays, there should be a comprehensive understanding of the principles, advantages, vulnerability, and precautions for interpretation. In the future, a combination of immunological biomarkers and genetic platforms will benefit patients with breast cancer by facilitating prognosis prediction and guiding therapeutic intervention.

2.
Ann Lab Med ; 40(3): 259-263, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31858767

RESUMO

There is an urgent need for accurate and rapid diagnostic assays capable of identifying carbapenemase-producing Enterobacteriaceae (CPE). We assessed the performance of the RESIST-4 O.K.N.V. (OKNV) assay (Coris BioConcept, Gembloux, Belgium) for the identification of oxacillinase (OXA)-48-like-, Klebsiella pneumoniae carbapenemase (KPC)-, New Delhi metallo-ß-lactamase (NDM)-, and Verona integron-encoded metallo-ß-lactamase (VIM)-producing Enterobacteriaceae grown on sheep blood agar (SBA) and the CHROMagar KPC medium. Sixty-five carbapenem-resistant Enterobacteriaceae (CRE) isolates with characterized carbapenemase content were used to evaluate the OKNV assay. The assay correctly identified all 30 isolates that produced one of the four targeted carbapenemase families. Additionally, it correctly identified 15 isolates that co-produced KPC and NDM, VIM and NDM or OXA-48-like and NDM, but failed to identify an NDM-1 and OXA-232 co-producing Klebsiella pneumoniae isolate. All 16 non-carbapenemase-producing CRE and four CPE isolates exhibited negative results, and no cross-reaction was observed. Overall, the sensitivity and specificity of the assay were 97.8% and 100%, respectively. The OKNV assay is an accurate and rapid assay for identifying OXA-48-like, KPC, NDM, and VIM carbapenemases produced by Enterobacteriaceae isolates cultured on both SBA and the CHROMagar KPC media in the clinical microbiology laboratory.

3.
Therap Adv Gastroenterol ; 12: 1756284819891081, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31839806

RESUMO

Background: The primary objective of this study was to analyze the cross-reactivity of antidrug antibodies to reference adalimumab (ADL) and SB5 (adalimumab biosimilar) in patients with inflammatory bowel disease (IBD) or rheumatoid arthritis (RA). Methods: Sera from patients with IBD and RA with or without antibodies to adalimumab (ATA+ or ATA-, respectively) were tested for cross-reactivity with SB5 and ADL. Functional inhibition of tumor necrosis factor-α binding was measured. Sera from patients with antibodies to reference infliximab (ATI+) were examined for cross-reactivity to SB5. Sera were tested by enzyme-linked immunosorbent assay. Results: All 30 anti-ADL ATA+ sera from patients with IBD and all 4 anti-SB5 ATA+ sera from patients with RA were cross-reactive with ADL and SB5 (range of mean concentrations: IBD, 20.99-21.31 µg/ml; RA, 16.46-17.48 µg/ml). In general, there was no significant difference between mean ATA titers. A strong correlation was detected in all ATA+ samples (rho = 0.997 to >0.999; p < 0.001 each). However, ATA- sera were not reactive to either ADL or SB5. anti-ADL ATA+ sera similarly neutralized functional activity of ADL and SB5; no functional inhibition was observed with ATA- sera. ATI+ sera did not cross-react with SB5. Conclusions: ADL and SB5 show cross-immunogenicity in sera from patients with IBD or RA, supporting shared immune-dominant epitopes. ATI+ sera did not cross-react with SB5, suggesting different immunogenic epitopes between infliximab and SB5.

4.
Tissue Eng Regen Med ; 16(4): 385-393, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31413942

RESUMO

Background: Human adipose tissue is routinely discarded as medical waste. However, this tissue may have valuable clinical applications since methods have been devised to effectively isolate adipose-derived extracellular matrix (ECM), growth factors (GFs), and stem cells. In this review, we analyze the literature that devised these methods and then suggest an optimal method based on their characterization results. Methods: Methods that we analyze in this article include: extraction of adipose tissue, decellularization, confirmation of decellularization, identification of residual active ingredients (ECM, GFs, and cells), removal of immunogens, and comparing structural/physiological/biochemical characteristics of active ingredients. Results: Human adipose ECMs are composed of collagen type I-VII, laminin, fibronectin, elastin, and glycosaminoglycan (GAG). GFs immobilized in GAG include basic fibroblast growth factor (bFGF), transforming growth factor beta 1(TGF-b1), insulin like growth factor 1 (IGF-1), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), BMP4 (bone morphogenetic protein 4), nerve growth factor (NGF), hepatocyte growth factor (HGF), and epithermal growth factor (EGF). Stem cells in the stromal-vascular fraction display mesenchymal markers, self-renewal gene expression, and multi-differentiation potential. Conclusion: Depending on the preparation method, the volume, biological activity, and physical properties of ECM, GFs, and adipose tissue-derived cells can vary. Thus, the optimal preparation method is dependent on the intended application of the adipose tissue-derived products.

5.
PeerJ ; 7: e7229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31341730

RESUMO

Background: Health education can benefit people with chronic diseases. However, in previous research those benefits were small, and reinforcement to maintain them was not effective. A possible explanation is that the benefits appeared to be small and reinforcement appeared to be ineffective because those analyses mixed data from two latent groups: one group of people who needed reinforcement and one group of people who did not. The hypothesis is that mixing the data from those two different groups caused the true effects to be "diluted." Methods: To test that hypothesis we used data from the Chronic Disease Self-Management Program in Japan, focusing on anxiety, depression, and patient-physician communication. To identify latent trajectories of change after the program, we used growth-mixture modeling. Then, to find out which baseline factors were associated with trajectory-group membership, we used logistic regression. Results: Growth-mixture modeling revealed two trajectories-two groups that were defined by distinct patterns of change after the program. One of those patterns was improvement followed by backsliding: decay of impact. On anxiety and depression the decay of impact was large enough to be clinically important, and its prevalence was as high as 50%. Next, logistic regression analysis revealed that being in the decay-of-impact group could be predicted from multimorbidity, low self-efficacy, and high scores on anxiety or depression at baseline. In addition, one unexpected finding was an association between multimorbidity and better patient-physician communication. Conclusions: These results support the hypothesis that previous findings (i.e., apparently small effect sizes and apparently ineffective reinforcement) actually reflect "dilution" of large effects, which was caused by mixing of data from distinct groups. Specifically, there was one group with decay of impact and one without. Thus, evaluations of health education should include analyses of trajectory-defined groups. These results show how the group of people who are most likely to need reinforcement can be identified even before the educational program begins. Extra attention and reinforcement can then be tailored. They can be focused specifically to benefit the people with the greatest need.

6.
Clin Lab ; 65(4)2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30969071

RESUMO

BACKGROUND: Cardiac troponin I (TnI) is one of the most crucial biomarkers for the management of acute coronary syndrome. However, the TnI values can vary when using commercial TnI assays from different vendors. We assessed the feasibility of TnI harmonization using plasma and serum samples. METHODS: Leftover plasma and serum samples were collected from patients and stored for further analysis (n = 200). TnI measurements were performed using 3 different analyzers. The TnI values for plasma and serum were compared, and the mathematical recalibration was performed using the mean of 3 values from each analyzer as a reference value. The number of biased cases was counted before and after recalibration. RESULTS: The final analysis was performed in a total of 140 plasma and serum samples, and constant and/or proportional differences for each analyzer were observed. Mathematical recalibration of the TnI values resulted in improved correlation to the reference values. The number of TnI values that were remote from the reference values decreased after recalibration. The effects were more evident for serum samples. CONCLUSIONS: In this study, we reassured the possibility of TnI harmonization among 3 different immunoassays using plasma and serum samples. It is important to note the differences between sample types during TnI harmonization.


Assuntos
Biomarcadores/sangue , Técnicas de Laboratório Clínico/instrumentação , Técnicas de Laboratório Clínico/métodos , Imunoensaio/normas , Plasma , Soro , Troponina I/sangue , Síndrome Coronariana Aguda/sangue , Calibragem , Humanos , Modelos Teóricos , Infarto do Miocárdio/sangue , Valores de Referência , Troponina T/sangue
7.
Kidney Res Clin Pract ; 38(2): 205-211, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-30841691

RESUMO

Background: Elevated serum alkaline phosphatase (AP) and γ-glutamyl transferase (γ-GT) are commonly observed in patients with acute pyelonephritis. The goal of this study was to examine the clinical significance of elevated serum AP and γ-GT levels and to explore the mechanisms underlying these changes. Methods: We examined serum AP and γ-GT levels in 438 patients with acute pyelonephritis. Urine AP/creatinine (Cr), urine γ-GT/Cr, fractional excretion of AP, and fractional excretion of γ-GT (FEγ-GT) were evaluated in patients with elevated and normal serum levels. AP isoenzymes were also examined. Results: We identified 77 patients (17.6%) with elevated serum AP and 134 patients (30.6%) with elevated serum γ-GT. Among them, both enzymes were elevated in 64 patients (14.6%). Older age, longer hospital stay, elevated baseline serum Cr, and complicated pyelonephritis were associated with increases in serum AP and γ-GT. Multivariate analysis showed that high serum AP levels were significantly correlated with renal impairment (odds ratio, 2.13; 95% confidence interval, 1.08-4.19; P = 0.029). FEγ-GT was significantly lower in patients with elevated serum enzyme levels. The liver fraction for AP isoenzyme profile did not increase in patients with elevated serum AP. Conclusion: Our results demonstrated that elevated serum AP and γ-GT levels are associated with complicated pyelonephritis and renal impairment. Lower FEγ-GT levels in patients with elevated serum enzymes may be the result of decreased urinary excretion of these enzymes.

8.
Artigo em Inglês | MEDLINE | ID: mdl-30405744

RESUMO

Anticoagulant therapy is used to reduce the risk of thromboembolic events in patients with atrial fibrillation. Warfarin has been the traditional anticoagulant but is difficult to use because of its narrow therapeutic window. Recently, newer oral anticoagulants (NOACs) have been developed. However, bleeding continues to be a significant complication. The objective of this study was to assess the safety of acupuncture in patients taking NOACs. The medical records in the Stroke Center at Kyung Hee University Korean Medicine Hospital were retrospectively reviewed to identify patients who had received acupuncture between January 2017 and September 2017. The patients were divided into groups according to whether they were taking an NOAC, an antiplatelet agent, or no anticoagulant therapy. Bleeding-related side effects that occurred immediately after removal of acupuncture needles were recorded. Three hundred and sixteen patients underwent 10,177 acupuncture sessions during the study period. Microbleeding (bleeding that ceased within 30 s) occurred at a rate of 3.9% in the NOAC group, 5.6% in the antiplatelet group, and 5.1% in the control group. There were no between-group differences in the microbleeding rate. No serious adverse events, including major bleeding, were detected. These findings indicate that acupuncture is safe in patients taking NOACs.

9.
Ann Clin Microbiol Antimicrob ; 17(1): 20, 2018 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-29728111

RESUMO

BACKGROUND: Nosocomial outbreak due to carbapenem-resistant Enterobacteriaceae has become serious challenge to patient treatment and infection control. We describe an outbreak due to a multidrug-resistant Providencia rettgeri from January 2016 to January 2017 at a University Hospital in Seoul, Korea. METHODS: A total of eight non-duplicate P. rettgeri isolates were discovered from urine samples from eight patients having a urinary catheter and admitted in a surgical intensive care unit. The ß-lactamase genes were identified using polymerase chain reaction and direct sequencing, and strain typing was done with pulsed-field gel electrophoresis (PFGE). RESULTS: All isolates showed high-level resistance to extended-spectrum cephalosporins, aztreonam, meropenem, ertapenem, ciprofloxacin, and amikacin. They harbored the blaNDM-1 carbapenemase and the blaPER-1 type extended-spectrum ß-lactamases genes. PFGE revealed that all isolates from eight patients were closely related strains. CONCLUSIONS: The 13-month outbreak ended following reinforcement of infection control measures, including contact isolation precautions and environmental disinfection. This is the first report of an outbreak of a P. rettgeri clinical isolates co-producing NDM-1 and PER-1 ß-lactamase.


Assuntos
Surtos de Doenças , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Providencia/genética , Providencia/isolamento & purificação , Providencia/patogenicidade , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Eletroforese em Gel de Campo Pulsado/métodos , Feminino , Genes Bacterianos/genética , Humanos , Unidades de Terapia Intensiva , Masculino , Testes de Sensibilidade Microbiana , Providencia/efeitos dos fármacos , República da Coreia/epidemiologia , Cateteres Urinários/microbiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Urina/microbiologia , beta-Lactamases/genética
10.
Ann Lab Med ; 38(5): 420-424, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29797811

RESUMO

BACKGROUND: The urinary albumin/creatinine ratio (ACR) is an important indicator of albuminuria. We aimed to estimate ACR uncertainty and its impact on test results and proposed imprecision quality goals based on the estimated uncertainty. METHODS: The combined ACR uncertainty was calculated using the individual uncertainties of urinary albumin and creatinine. ACR confidence intervals (CIs) were estimated based on the expanded uncertainty. When the CI contained the ACR category boundary (30 or 300 mg/g), the cases were considered ambiguous. Quality goals for ACR were suggested using the number of ambiguous cases among actual patient results. RESULTS: The number of ambiguous cases resulting from the combined ACR uncertainty was higher than expected based on biological variation (BV) quality goals. When the ACR met BV quality specifications, we estimated that 4.8-15.5% of the results may have been misclassified. To minimize the number of ambiguous results, the minimum, desirable, and optimum quality goals were set at 34.0%, 18.0%, and 4.5%, respectively. CONCLUSIONS: We expressed ACR uncertainty using the uncertainties of urinary albumin and creatinine and assessed the impact of this combined uncertainty on the test results. Subsequently, we proposed imprecision quality goals for ACR based on ambiguous results.


Assuntos
Albuminas/análise , Albuminúria/diagnóstico , Creatinina/urina , Adulto , Albuminúria/classificação , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Incerteza
11.
Scand J Clin Lab Invest ; 78(4): 301-304, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29667904

RESUMO

Urine erythrocyte (Ery) and leukocyte (Leu) dipstick tests are essential for detecting microhematuria and urinary tract infection. Currently, there is no suggestion for establishing the cut-off limits in an ordinal scale test. This study aimed to establish the cut-off limits for urine Ery and Leu dipstick tests via probit regression. From 1 January 2016 to 30 June 2016, laboratory data were collected from patients at one teaching hospital whose specimen had analytical results from both a urine dipstick test and an automated urine particle analyzer. Probit regression was used to estimate the probability of positive urine dipstick results as a function of log-transformed urine Ery and Leu concentrations. Based on the analysis of 22,122 specimens, the estimated concentration that yields 50% positive results (C50) of the Ery weak+, 1+, 2+, 3+, and 4 + dipstick results were 14.6, 40.4, 51.6, 136.3 and 219.0 × 106/L, respectively. The estimated C50 of the Leu 1+, 2+ and 3 + dipstick results were 22.7, 67.9 and 283.9 × 106/L, respectively. The estimated values were different from arbitrary concentrations provided for each dipstick category by the manufacturer. If a quantitative comparison method/procedure is available, the cut-off limits of an ordinal scale test can be established using probit regression. Each laboratory should investigate the transferability of the arbitrary concentrations provided by the manufacturer, and if necessary, determine its own cut-off limits of urine Ery and Leu dipstick tests.


Assuntos
Eritrócitos/citologia , Leucócitos/citologia , Fitas Reagentes , Urinálise/métodos , Intervalos de Confiança , Humanos , Valores de Referência , Análise de Regressão , Sensibilidade e Especificidade
12.
Ann Clin Lab Sci ; 48(1): 75-80, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29531000

RESUMO

Protein induced by vitamin K absence (PIVKA) is measured using various assays and is used to help diagnose hepatocellular carcinoma. The present study evaluated the analytical and clinical performances of the recently released Abbott Architect PIVKA assay. Precision, linearity, and correlation tests were performed in accordance with the Clinical Laboratory Standardization Institute guidelines. Sample type suitability was assessed using serum and plasma samples from the same patients, and the reference interval was established using sera from 204 healthy individuals. The assay had coefficients of variation of 3.2-3.5% and intra-laboratory variation of 3.6-5.5%. Linearity was confirmed across the entire measurable range. The Architect PIVKA assay was comparable to the Lumipulse PIVKA assay, and the plasma and serum samples provided similar results. The lower reference limit was 13.0 mAU/mL and the upper reference limit was 37.4 mAU/mL. The ability of the Architect PIVKA assay to detect hepatocellular carcinoma was comparable to that of the alpha-fetoprotein test and the Lumipulse PIVKA assay. The Architect PIVKA assay provides excellent analytical and clinical performance, is simple for clinical laboratories to adopt, and has improved sample type suitability that could broaden the assay's utility.


Assuntos
Automação Laboratorial/normas , Biomarcadores Tumorais/sangue , Biomarcadores/sangue , Carcinoma Hepatocelular/diagnóstico , Imunoensaio/métodos , Neoplasias Hepáticas/diagnóstico , Precursores de Proteínas/sangue , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/genética , Humanos , Limite de Detecção , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/genética , Protrombina , Valores de Referência
13.
Microb Drug Resist ; 24(5): 627-634, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29298123

RESUMO

Pseudomonas putida group are Gram-negative bacilli with polar flagellation, which are ubiquitous in the environment, although they are rarely involved in human infections. The aim of this study was to identify the dissemination of VIM-2-producing P. putida group in clinical isolates from a hospital in Korea. Thirteen strains were collected from 2014 to 2015 for the study. The isolates were recovered from urine cultures of both inpatients and outpatients at the hospital. Minimum inhibitory concentrations of antibiotics were determined by Etest. Carbapenemase genes were amplified by polymerase chain reaction and sequenced. Pulsed-field gel electrophoresis was performed for strain typing. Whole-genome sequencing was carried out randomly for two strains chosen from each year of the study to analyze the plasmid structure carrying the blaVIM-2 genes. The 13 isolates carried nine different class I integrons harboring VIM-2 and were resistant to meropenem and imipenem (minimum inhibitory concentrations, ≥32 µg/ml), thus exhibiting a multidrug-resistant phenotype. The blaVIM-2 gene was located on a plasmid in seven of the isolates and on the chromosome in six isolates. Each case of the blaVIM-2 gene was disseminated by clonal spread, horizontal transfer, and was mostly an occasional occurrence. In this study, we demonstrated that multidrug-resistant P. putida group carrying VIM-2 has reemerged in human specimens in Korea.


Assuntos
DNA Bacteriano/genética , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Pseudomonas/microbiologia , Pseudomonas putida/genética , Pseudomonas putida/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Feminino , Hospitais Universitários , Humanos , Masculino , Testes de Sensibilidade Microbiana/métodos , Pessoa de Meia-Idade , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas putida/efeitos dos fármacos , República da Coreia
14.
Clin Chim Acta ; 477: 13-17, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29198989

RESUMO

BACKGROUND: The estimated glomerular filtration rate (eGFR) is an important parameter in the management of patients with kidney diseases, yet eGFR quality goals are lacking. We examined the uncertainties in eGFR determinations and assessed their impact on patient classifications, aiming to set eGFR quality goals. METHODS: Adult patients undergoing creatinine concentration assessments at our hospital, between June 2014 and October 2016, were included (N=285,982). Using 7 eGFR equations, we calculated the imprecisions in the eGFR, based on the imprecisions in determining creatinine and/or cystatin C concentrations. The uncertainties in the eGFR were expressed as functions of creatinine and/or cystatin C concentration uncertainties. Subsequently, the number of ambiguous cases was assessed, based on the calculated uncertainty in the eGFR. RESULTS: Uncertainties in the eGFRs varied according to the eGFR calculation equation used. Although a 0.8% expanded uncertainty in the eGFR caused a 3.5% ambiguous case rate, a 10% expanded uncertainty resulted in a 42.3% rate of ambiguous cases. To meet minimal quality requirements, creatinine imprecision should be ≤3.0%. CONCLUSIONS: Even a low level of uncertainty in the eGFR may cause noticeable impacts on patient classifications. Laboratory physicians should be aware, and cautious, of the uncertainties in eGFR calculations.


Assuntos
Creatinina/sangue , Cistatina C/sangue , Taxa de Filtração Glomerular , Nefropatias/sangue , Adolescente , Adulto , Humanos , Testes de Função Renal , Estudos Retrospectivos , Adulto Jovem
15.
Am J Clin Pathol ; 148(4): 323-329, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-28967949

RESUMO

Objectives: To assess the utility of reference change values (RCVs) as delta check limits. Methods: A total of 1,650,518 paired results for 23 general chemistry test results from June 1, 2014, to October 31, 2016, were analyzed. The RCVs for each analyte were calculated from the analytical imprecision and within-subject biological variation. The percent differences between two consecutive results in one patient were categorized into one of four groups: outpatients, inpatients, emergency care, and general health care. For each, 2.5th and 97.5th percentile values were computed and compared with their RCVs. The distributions were assessed for normality using the Kolmogorov-Smirnov test. Results: Most of the estimated limits were larger than the corresponding RCVs and, furthermore, with notable differences across the groups. Patients in the emergency care group usually demonstrated larger delta percent values than those in the other groups. None of the distributions of the percent differences passed tests of normality when subjected to Kolmogorov-Smirnov analysis. Conclusions: Comparison of estimated RCVs and real-world patient data revealed the pitfalls of applying RCVs in clinical laboratories. Laboratory managers should be aware of the limitations of RCVs and exercise caution when using them.


Assuntos
Análise Química do Sangue/normas , Química Clínica/normas , Humanos , Valores de Referência
16.
Surg Obes Relat Dis ; 13(8): 1361-1368, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28668209

RESUMO

BACKGROUND: Metabolic surgery is an effective option for treatment of type 2 diabetes. Although body mass index (BMI) has several limitations in differentiating the metabolic risks of the same weight of muscle and fat, it is used as the basis of indication for metabolic surgery. OBJECTIVES: Since visceral fat is highly associated with metabolic disease, we evaluated the effectiveness of visceral fat proportion (VFP) for predicting metabolic risk preoperatively. SETTING: University hospital. METHODS: Fifty-two type 2 diabetes patients with BMI≤35 kg/cm2 who underwent gastrectomy for gastric cancer were included. Pre- and postoperative VFPs were measured using abdominal computed tomography. Multivariate logistic regression analysis was performed to estimate the effect of VFP on type 2 diabetes. Receiver operating curve analysis was used to estimate the effectiveness of VFP as a predictor of type 2 diabetes improvement. RESULTS: Thirty-three of the 52 patients (63%) showed improved type 2 diabetes postoperatively. Low preoperative VFP (odds ratio [OR] = .913; 95% confidence interval [CI] = .835-.999; P = .048) and low glycated hemoglobin level (OR = .357; 95% CI = .172-.742; P = .006) were associated with type 2 diabetes improvement 2 years after gastrectomy. The area under the curve was 70.2%, indicating moderate accuracy. CONCLUSIONS: Preoperative VFP might be a reasonable predictive factor for type 2 diabetes improvement after gastrectomy for patients with a BMI≤35 kg/cm2. High-quality studies of visceral fat for metabolic function are needed in the future.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2/cirurgia , Gastrectomia , Gordura Intra-Abdominal/patologia , Idoso , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/patologia , Feminino , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Medição de Risco/métodos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Obstet Gynecol Sci ; 60(2): 232-235, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28344968

RESUMO

Venous thromboembolism is well known as one of the rare but serious adverse effects of combined oral contraceptives (COCs). The COCs with third and fourth generation progestogens were found to have higher risk of venous thrombosis than those with second generation progestogens. We present a case of pulmonary embolism in a 23-year-old nulligravid woman who was using COCs containing the third generation progestogen (desogestrel). At the time of presentation of the adverse effect, she had been using the COCs for 4 months. She had no additional risk factors for thrombosis such as smoking, surgery, tumor as well as genetic factors. This case demonstrates even young women in otherwise good health may be at risk of venous thromboembolism from low-dose formulations of COCs as an over-the-counter drug. We describe this case with a brief review of literatures.

18.
Oncotarget ; 7(50): 82876-82888, 2016 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-27756880

RESUMO

Therapies targeting SRC family kinases (SFKs) have shown efficacy in treating non-small cell lung cancer (NSCLC). However, recent clinical trials have found that the SFK inhibitor dasatinib is ineffective in some patient cohorts. Regardless, dasatinib treatment may benefit some NSCLC patient subgroups. Here, we investigated whether expression of LYN, a member of the SFK family, is associated with patient survival, the efficacy of dasatinib, and/or NSCLC cell viability. LYN expression was associated with poor overall survival in a multivariate analysis, and this association was strongest in non-smoker female patients with adenocarcinoma (ADC). In lung ADC cells, LYN expression enhanced cell proliferation, migration, and invasion. Dasatinib inhibited LYN activity and decreased cell viability in LYN-positive ADC cell lines and xenografts. Additionally, we identified the SFKs SRC and YES as candidate dasatinib targets in LYN-negative ADC cell lines. Our findings suggest that LYN is a useful prognostic marker and a selective target of dasatinib therapy in the lung ADC subpopulation especially in female non-smokers with lung ADC.


Assuntos
Adenocarcinoma/tratamento farmacológico , Antineoplásicos/uso terapêutico , Biomarcadores Tumorais/antagonistas & inibidores , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Dasatinibe/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Quinases da Família src/antagonistas & inibidores , Adenocarcinoma/enzimologia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma de Pulmão , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Carcinoma Pulmonar de Células não Pequenas/enzimologia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/enzimologia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Invasividade Neoplásica , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Ensaios Antitumorais Modelo de Xenoenxerto , Adulto Jovem , Quinases da Família src/genética , Quinases da Família src/metabolismo
19.
Ann Lab Med ; 36(6): 529-35, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27578505

RESUMO

BACKGROUND: The emergence of carbapenemase-producing Enterobacteriaceae (CPE) represents a major clinical problem because these bacteria are resistant to most antibiotics. CPE remain relatively uncommon in Korea. We report the prevalence, clinical characteristics, and molecular epidemiology of CPE isolates collected from five university hospitals in Korea. METHODS: Between January and December 2015, 393 non-duplicated isolates that were nonsusceptible to ertapenem were analyzed. Production of carbapenemase, extended-spectrum ß-lactamase, and AmpC ß-lactamase was determined by genotypic tests. Antimicrobial susceptibility profiles were determined by using an Etest. Clonality of Klebsiella pneumoniae carbapenemase (KPC)-2-producing and oxacillinase (OXA)-232-producing Klebsiella pneumoniae isolates was determined by pulsed-field gel electrophoresis (PFGE). RESULTS: Of the 393 isolates tested, 79 (20.1%) were CPE. Of these 79 isolates, 47 (59.5%) harbored the bla(OXA-232) gene while the remaining isolates carried genes bla(KPC-2) (n=27), bla(IMP-1) (n=4), and bla(NDM-1) (n=1). Among the 24 KPC-2 K. pneumoniae isolates from hospital B, 100% were resistant to carbapenems, 8% to colistin, and 0% to tigecycline. Among the 45 OXA-232 K. pneumoniae at hospital C, 95% were resistant to ertapenem, 68% to imipenem, 95% to meropenem, 10% to colistin, and 24% to tigecycline. PFGE analysis revealed a unique pattern for KPC-2 K. pneumoniae and identified 30 isolates belonging to the dominant pulsotypes (PT)1 and PT2 among 41 OXA-232 K. pneumoniae isolates. CONCLUSIONS: CPE strains are present in Korea, with the majority of K. pneumoniae isolates producing OXA-232 and KPC-2. The prevalence and predominant genotypes of CPE show hospital-specific differences.


Assuntos
Proteínas de Bactérias/genética , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/enzimologia , beta-Lactamases/genética , Idoso , Antibacterianos/farmacologia , Proteínas de Bactérias/metabolismo , Farmacorresistência Bacteriana , Eletroforese em Gel de Campo Pulsado , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/epidemiologia , Feminino , Genótipo , Hospitais , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , República da Coreia/epidemiologia , beta-Lactamases/metabolismo
20.
Ann Lab Med ; 36(6): 599-602, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27578515

RESUMO

Hemolysis frequently causes preanalytical errors in laboratory measurements. We aimed to develop a quality improvement indicator for evaluating the extent of inappropriate procedures causing hemolysis in clinical samples collected in medical care units. We defined the threshold value of the hemolysis index (H index) causing significant interference with analyte measurement and analyzed the H index values of clinical samples in relation to the threshold. The H index threshold value causing a 10% bias in the measurement of lactate dehydrogenase was found to be 25. The monthly mean H index and monthly frequency of samples with an H index >25 were significantly different among the types of ward (P=0.001, respectively), and significantly decreased after replacement of a laboratory centrifuge lacking temperature control (20.6±0.58 vs 23.30±1.08, P=0.01; 23.4±1.69% vs 32.6±1.78%, P=0.01). The monthly mean H index and the monthly frequency of samples with an H index above a threshold value may be useful quality improvement indicators for detection of inappropriate procedures in the acquisition and handling of blood samples in medical care units.


Assuntos
Laboratórios Hospitalares/normas , Melhoria de Qualidade/normas , Hemoglobinas/análise , Hemólise , Humanos , L-Lactato Desidrogenase/análise , Manejo de Espécimes
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