Sex-Biased Molecular Signature for Overall Survival of Liver Cancer Patients

Sex/gender disparity has been shown in the incidence and prognosis of many types of diseases, probably due to differences in genes, physiological conditions such as hormones, and lifestyle between the sexes. The mortality and survival rates of many cancers, especially liver cancer, differ between men and women. Due to the pronounced sex/gender disparity, considering sex/ gender may be necessary for the diagnosis and treatment of liver cancer. By analyzing research articles through a PubMed literature search, the present review identified 12 genes which showed practical relevance to cancer and sex disparities. Among the 12 sex-specific genes, 7 genes (BAP1, CTNNB1, FOXA1, GSTO1, GSTP1, IL6, and SRPK1) showed sex-biased function in liver cancer. Here we summarized previous findings of cancer molecular signature including our own analysis, and showed that sexbiased molecular signature CTNNB1High , IL6High , RHOAHigh and GLIPR1Low may serve as a female-specific index for prediction and evaluation of OS in liver cancer patients. This review suggests a potential implication of sex-biased molecular signature in liver cancer, providing a useful information on diagnosis and prediction of disease progression based on gender.

Recurrence of Early Gastric Cancer in 5-Years Following Endoscopic Submucosal Dissection

Treatment of choice for early gastric cancer has changed from curative surgery to endoscopic therapy. And the indications for endoscopic treatment of early gastric cancer are expanded. A 70-year-old man was referred for further management of early gastric cancer. In endoscopy, early gastric cancer was suspected at antrum, greater curvature side of gastric body. Endoscopic submucosal dissection was performed. Histology revealed a 6.9×2.7-cm-sized tubular adenocarcinoma, moderately differentiated type and resection margin was negative. Following endoscopy was performed annually. Histology has changed from chronic inflammation to chronic gastritis with intestinal metaplasia, tubular adenoma with low grade dysplasia, tubular adenoma with high grade dysplasia year by year. Laparoscopic subtotal gastrectomy with lymphadenectomy was performed. Histologic finding showed well differentiated tubular adenocarcinoma confined in mucosal layer without lymph node metastasis.

Idiopathic Pleuroparenchymal Fibroelastosis Presenting in Recurrent Pneumothorax: A Case Report / 결핵및호흡기질환

Idiopathic pleuroparenchymal fibroelastosis (PPFE) is a rare, recently classified entity that consists of pleural and subjacent parenchymal fibrosis predominantly in the upper lungs. In an official American Thoracic Society/European Respiratory Society statement in 2013, this disease is introduced as a group of rare idiopathic interstitial pneumonias. We describe a case of a 76-year-old woman with cough and recurrent pneumothorax. She was admitted to our hospital with severe cough at first. High resolution computed tomography (HRCT) disclosed multifocal subpleural consolidations with reticular opacities in both lungs, primarily in the upper lobes, suggesting interstitial pneumonia. Rheumatoid lung was diagnosed initially through an elevated rheumatoid factor, HRCT and surgical biopsy at the right lower lobe. However, one month later, pneumothorax recurred. Surgical biopsy was performed at the right upper lobe at this time. The specimens revealed typical subpleural fibroelastosis. We report this as a first case of idiopathic PPFE in Korea after reviewing the symptoms, imaging and pathologic findings.

A case of Wegener's granulomatosis mimicking recurrent hemophagocytic lymphohistiocytosis

No abstract available.

A Case of Prolonged Hypogammaglobulinemia after Rituximab-Containing Chemotherapy in a Patient with Lymphoma / 대한내과학회지

Rituximab, an anti-CD20 monoclonal antibody, is an effective target agent against the B lymphocytes in B-cell lymphoid malignancies and various lymphoproliferative diseases. Moreover, the toxicity of rituximab is less severe than that of conventional cytotoxic agents, which has promoted the widespread application of rituximab in the treatment of B-cell lymphoma. However, depletion of B lymphocytes by rituximab, which leads to secondary hypogammaglobulinemia, can cause deterioration of humoral immunity. Although immune reconstitution after hematopoietic stem cell transplantation is known to prevent prolonged hypogammaglobulinemia, very few cases of long-standing hypogammaglobulinemia have been reported. We report herein a case of prolonged hypogammaglobulinemia after rituximab-containing chemotherapy and splenectomy in a patient with non-Hodgkin's lymphoma and discuss the clinical significance and pathogenetic mechanism of this phenomenon with a literature review.

Role of High-Resolution Magnetic Resonance Imaging in the Diagnosis of Primary Angiitis of the Central Nervous System

BACKGROUND: Primary angiitis of the central nervous system (PACNS) is a rare disorder and is often difficult to diagnose due to the lack of a confirmatory test. PACNS can generally be diagnosed based on typical angiographic findings. We describe herein a patient diagnosed with PACNS despite the presence of normal findings on conventional angiography. CASE REPORT: A 44-year-old man with a recent history of ischemic stroke in the right posterior cerebral artery territory developed acute-onset vertigo. Diffusion-weighted imaging revealed an acute infarction within the left posterior inferior cerebellar artery. His medical history was unremarkable except for hyperlipidemia; the initial examination revealed mild gait imbalance. During the 10 days of hospital admission, the patient experienced four recurrent ischemic strokes within the posterior circulation territory (occipital lobe, pons, and cerebellum). He was diagnosed with recurrent cerebral infarctions due to PACNS. The basilar artery exhibited no demonstrable luminal stenosis, but there were direct imaging signs of central nervous system angiitis including wall thickening and contrast enhancement. High-dose intravenous steroid therapy followed by oral prednisolone was administered. There was no further stroke recurrence and follow-up imaging of the arterial walls showed normalization of their characteristics. CONCLUSIONS: The present case emphasizes the importance of wall imaging in the diagnosis and treatment of PACNS.

Erratum: A case of Wegener's granulomatosis mimicking recurrent hemophagocytic lymphohistiocytosis

In the article cited above, Fig. 3 was input incorrectly.

The Relationship between Hippocampal Volume and Cognition in Patients with Chronic Primary Insomnia

BACKGROUND AND PURPOSE: Differences in hippocampal volume (HV) were compared between chronic primary insomniacs (PIs) and good sleepers (GSs), and the relationship between HV and memory function in PIs was investigated to clarify the effect of chronic sleep deprivation on brain structure and cognition. METHODS: Twenty PIs (mean age, 50 years; 18 females) and 20 age-, gender-, and education-matched GSs were enrolled. Brain magnetic resonance imaging (MRI) was performed on a 1.5-T MRI scanner. Left and right HV and intracranial volume (ICV) were measured manually. Nighttime polysomnography and neuropsychological testing were also applied to all subjects. Group differences in HV were analyzed and the relationships between HV and sleep questionnaire data, nighttime polysomnography, and neuropsychological findings were evaluated. RESULTS: Compared to GSs, PIs exhibited significantly increased sleep latency and arousal index and a decreased percentage of REM sleep in nighttime polysomnography, as well as impaired verbal and visual memory, and frontal lobe function. Absolute HV and ICV did not differ significantly between PIs and GSs. In the PIs, right and left HVs were negatively correlated with the duration of insomnia and the arousal index, and positively correlated with the recognition of visual memory. In addition, free recall in verbal memory was positively correlated with left HV in PIs. CONCLUSIONS: These findings suggest that chronic sleep deprivation impairs memory and frontal lobe function, and that a long duration of insomnia and poor sleep quality contribute to a bilateral reduction in HV.

Attitudes of Dialysis Unit Physicians with Regard to Withholding and Withdrawing Dialysis / 대한신장학회지

PURPOSE:In many countries, patients and dialysis unit physicians attempt to address issues regarding withholding and withdrawing dialysis through advance directives and clinical guidelines for dialysis utilization. However, there are only a few reports of withholding and withdrawing dialysis in Korea. This study was developed to investigate the attitudes of dialysis unit physicians regarding withholding and withdrawing dialysis in Korea. METHODS:A questionnaire survey was conducted among 45 dialysis unit physicians from January, 2006 to January, 2008. Physicians were asked about their decision making process to withhold and withdraw dialysis, and their opinions regarding the necessities of advance directives and guidelines for withholding and withdrawing dialysis. RESULTS:Analysis of surveys revealed that physicians agreed more about whether to withhold and withdraw dialysis in vegetative patients compared to patients with dementia ( p<0.001, p<0.001). There were more agreements about whether to withhold dialysis than whether to withdraw dialysis in patients with unimpaired cognition ( p<0.037). However, there were no differences in agreements between withholding and withdrawing dialysis in patients with severe neurological impairments. There appeared to be a general consensus regarding the need for guidelines addressing withholding and withdrawing dialysis (84.4%). However, opinions supporting the necessity for advance directives were not strongly favored (33.3%). CONCLUSION:Conflicting opinions are present among dialysis unit physicians regarding whether to withhold and withdraw dialysis according to a patient's neurological impairments. However, most dialysis unit physicians were of one accord regarding the need of guidelines for withholding and withdrawing dialysis.

Attitudes of Dialysis Unit Physicians with Regard to Withholding and Withdrawing Dialysis / 대한신장학회지

PURPOSE:In many countries, patients and dialysis unit physicians attempt to address issues regarding withholding and withdrawing dialysis through advance directives and clinical guidelines for dialysis utilization. However, there are only a few reports of withholding and withdrawing dialysis in Korea. This study was developed to investigate the attitudes of dialysis unit physicians regarding withholding and withdrawing dialysis in Korea. METHODS:A questionnaire survey was conducted among 45 dialysis unit physicians from January, 2006 to January, 2008. Physicians were asked about their decision making process to withhold and withdraw dialysis, and their opinions regarding the necessities of advance directives and guidelines for withholding and withdrawing dialysis. RESULTS:Analysis of surveys revealed that physicians agreed more about whether to withhold and withdraw dialysis in vegetative patients compared to patients with dementia ( p<0.001, p<0.001). There were more agreements about whether to withhold dialysis than whether to withdraw dialysis in patients with unimpaired cognition ( p<0.037). However, there were no differences in agreements between withholding and withdrawing dialysis in patients with severe neurological impairments. There appeared to be a general consensus regarding the need for guidelines addressing withholding and withdrawing dialysis (84.4%). However, opinions supporting the necessity for advance directives were not strongly favored (33.3%). CONCLUSION:Conflicting opinions are present among dialysis unit physicians regarding whether to withhold and withdraw dialysis according to a patient's neurological impairments. However, most dialysis unit physicians were of one accord regarding the need of guidelines for withholding and withdrawing dialysis.

A Case of Lactic Acidosis Associated with Prolonged Linezolid Therapy / 대한신장학회지

Lactic acidosis is the most common cause of metabolic acidosis in hospitalized patients. Although impaired tissue oxygenation is usually responsible for the rise in lactate production, lactic acidosis could be caused by drugs including metformin and the nucleoside reverse-transcriptase inhibitors. Linezolid, an oxazolidinone antibiotic, is currently indicated to treat serious infections caused by vancomycin-resistant enterococcus and other gram-positive organisms. A 74-year old woman was found to have pyogenic vertebral osteomyelitis and treated with linezolid. Thirty-one days after linezolid therapy, she developed severe lactic acidosis. We report a case of lactic acidosis associated with prolonged linezolid therapy.

Two Cases of Acute Renal Failure Associated with Aprotinin / 대한신장학회지

Aprotinin is a nonspecific serine protease inhibitor and antifibrinolytic agent. It has been used to control bleeding and reduce the amounts of transfusion during the perioperative period. There are few reports on adverse effects following aprotinin use. However, several reports have been recently published, suggesting an increased risk for renal events or deaths in patients given aprotinin. We report two cases of ARF associated with aprotinin. To reduce perioperative blood loss, aprotinin was administered to two patients who underwent obstetrical surgeries in which ARF subsequently developed. Renal biopsies displayed microthrombi within the arterioles and small arteries, causing infarctions and collapses of glomeruli. Although renal functions were not completely recovered, the two patients are now being followed up without dialysis

A Case of Acute Phosphate Nephropathy after Sodium Phosphate Preparation / 대한신장학회지

Nephrocalcinosis is described as the deposition of calcium crystals in the renal parenchyma that result from prolonged states of hypercalcemia. Recently recognized is the deposition of calcium phosphate in the renal tubular injury by using sodium phosphate cathartics commonly used for the colonic cleansing. This phenomenon was termed phosphate nephropathy. Acute renal failure secondary to phosphate nephropathy has been increasingly recognized as a complication after the administration of sodium phosphate solution for colonoscopy. We report a case of acute phosphate nephropathy following oral sodium phosphate solution to cleanse the bowel for colonoscopy. A renal biopsy showed diffuse tubular calcium deposition.

Clinicopathologic Findings in Obesity-related Glomerulopathy / 대한신장학회지

PURPOSE: Recently, obesity with metabolic syndrome is considered as an important risk factor in the development and progression of chronic kidney disease (CKD). Glomerulomegaly and focal segmental glomerulosclerosis (FSGS) are found in the obese patients, suggesting that investigation of structural- functional relationship in the obesity-related glomerulopathy (ORG) is needed to prevent CKD. Thus, we report here clinical and pathologic characteristics of ORG and its association with other clinical variables. METHODS: Obesity was defined by body mass index >25 kg/m2 and ORG morphologically by FSGS and glomerulomegaly or glomerulomegaly alone. Clinicopathologic findings and glomerular sizes of ORG (14 cases) were compared with age-matched controls with thin basement membrane disease. Multiple variable analysis was performed between glomerular size and clinical variables. RESULTS: There was no nephrotic syndrome or pretibial pitting edema in all obese patients. Mean glomerular diameter was increased in obese patients compared to controls (240+/-21 micrometer vs 197+/-21 micrometer, p=0.001). Seven cases had lesions with FSGS with glomerulomegaly and seven cases glomerulomegaly alone. Mild tubular atrophy, interstitial fibrosis and arteriolosclerosis were observed in more than half of patients. In obese patients, seven patients with FSGS had more elevated systolic blood pressure and tubular interstitial fibrosis compared to patients with glomerulomegaly only. Patients' systolic blood pressure and waist circumference were independent risk factors influencing the glomerular size in obese patients. CONCLUSION: FSGS or glomerulomegaly are prominent even in the mild obesity with insignificant clinical symptoms. This indicates that the clinical attention to glomerular disease is needed in obese patients.

Osteomyelitis of the Rib Following Internal Jugular Vein Catheter Insertion / 대한신장학회잡지

Internal jugular vein catheter is frequently used for emergency hemodialysis. Various complications have been reported. Infection is one of the problem after long term use. There have been reports of osteomyelitis of clavicle secondary to subclavian catheterization but not osteomyelitis associated with internal jugular vein catheterization. There are two possible pathways of infection. One is hematogenous spread from another focus in the body or sepsis. The other is transmission of focal infection. Manipulation of the needle may perforate the vein and produce hematoma. The infected hematoma may have resulted in abscess formation around the rib and subsequent osteomyelitis. Herein we report a case of osteomyelitis of the rib complicating internal jugular vein catheterization with a review of the literature.

A Case of Pulmonary Hemorrhage Associated with IgA Nephropahty in Adult / 대한신장학회잡지

IgA nephropathy is the most common glomerulonephritis in all parts of the world. It presents as asymptomatic microscopic hematuria or proteinuria or as episodic gross hematuria after upper respiratory infection or excercise. Pulmonary hemorrhage is both a rare complication and presentation of IgA nephropathy. We report a case of pulmonary hemorrhage associated with IgA nephropathy in adult. A 29-year-old woman was transferred because of gross hematuria and hemoptysis after hysterectomy. Chest X-ray showed bilateral pulmonary infiltrates in lower lobes. Renal biopsy showed mesangial expansion by mesangial cellular proliferation with mesangial staining of IgA. Her repiratory symptom and pathcy opacities on the chest X-ray disappeared spontaneously. Normal renal function of the patient maintained but she had persistent hematuria.

Serum C-Reactive Protein: A Predictor of Mortality in Continuous Ambulatory Peritoneal Dialysis(CAPD) Patients / 대한신장학회잡지

An increased serum C-reactive protein(sCRP) has been demonstrated to be an independent marker of mortality in hemodialysis patients, but predictive role of sCRP in CAPD patients is not clear. To evaluate the predictive value of the single baseline sCRP as a marker of mortality, we performed a cross-sectional study involving 105 CAPD patients and have followed these patients for 2 years. The mean age was 49 years; the male to female ratio was 0.9:1; mean CAPD duration was 43.5 months; 11.4% of patients had diabetes and 9.5% of patients had cardiovascular disease. Patients were divided into two groups based on sCRP level: normal sCRP group(n=92, sCRP0.8mg/dl). The mean sCRP levels were 0.15+/-0.17 mg/dl and 4.25+/-5.04mg/dl, respectively(P<0.05). In increased sCRP group, there were more diabetic patients(30.7 vs. 8.6%, P<0.05), and serum albumin level was significantly lower compared to normal sCRP group(3.5+/-0.6 vs. 3.9+/-0.5g/dl, P<0.05). Other biochemical, urea kinetic and anthropometric data showed no difference between the two groups. Two- year patient survival rate was significantly lower in increased sCRP group than normal sCRP group(66.7 vs. 94.1%, P=0.001) although there was no significant difference in technique failure, peritonitis rate and hospitalized days between the two groups. By Cox proportional hazards analysis, independent predictors of mortality were cardiovascular disease (relative risk, RR=8.96, P<0.005), increased sCRP level(RR=1.19, P<0.05) and high hematocrit(RR=1.18, P<0.05). Serum CRP was negatively correlated with serum albumin(r=-0.20, P<0.05) and positively correlated with the presence of diabetes mellitus(r=0.31, P=0.001) by stepwise multiple regression analysis. In conclusion, sCRP at enrollment appears to be an independent predictor of 2-year patient survival in CAPD patients.

Serum Albumin as a Predictor of Morbidity and Mortality in Continuous Ambulatory Peritoneal Dialysis(CAPD) Patients / 대한신장학회잡지

Serum albumin(SA) is a powerful predictor of morbidity and mortality in hemodialysis(HD) population. In CAPD patients, SA may be more severely compromised because of large dialysate protein losses and lower protein intake relative to HD patients. However, the usefulness of SA as a marker for increased morbidity and mortality in CAPD patients remains undefined. To investigate the role of SA and other risk factors as predictors of peritonitis, hospitalization and death in CAPD patients, we conducted this retrospective study on 782 patients who were followed-up for more than 3 months after initiation of CAPD at Severance Hospital from January 1985 through August 1995. For each patient the following data were collected: age, sex, duration on dialysis, presence of diabetes mellitus or cardiovascular disease, and monthly biochemical data including SA. 1) The mean age of the patients was 45.5+/-13.6 years(range, 14-80) with sex ratio 1.2:1 and mean duration on dialysis was 30.8+/-25.6 months(range, 3- 122). 2) Independent factors affecting serum albumin level were creatinine(beta=0.301, por=4.0g/dL), and incidence of peritonitis, hospitalization and death were compared among them. Compared to group 2 and group 3, group 1 had significantly higher peritonitis rate(1.18 vs. 0.87, 0.66 times/year/patient, p<0.05) and hospitalization(7.93 vs. 4.70, 3.36 days/year/patient, p<0.05). The 5- year survival rates in group 1, group 2 and group 3 were 43.4%, 60.9% and 84.1%, respectively (p<0.05). In conclusion, low SA is an important and strong predictor for morbidity and mortality in CAPD patients. Prospective studies are needed to determine if aggressive intervention with nutritional supplements could improve the SA level and to determine if such an improvement would impact on morbidity and mortality.

Inducible Nitric Oxide Synthase (iNOS) Expression Is Increased in Lipopolysaccharide (LPS)-Stimulated Diabetic Rat Glomeruli: Effect of ACE Inhibitor and Angiotensin II Receptor Blocker

Previously, we reported that high glucose enhanced cytokine-induced nitric oxide (NO) production by rat mesangial cells (MCs), and that the enhanced expression of the iNOS pathway may promote extracellular matrix accumulation by MCs. The present study was designed to examine whether the iNOS pathway is pathologically altered in experimental diabetic nephropathy, and whether therapy with angiotensin converting enzyme (ACE) inhibitor (imidapril: I) or angiotensin II type I receptor (AT1) blocker (L-158,809: L), ameliorates these changes. Male Sprague-Dawley rats were injected with diluent (control: C) or streptozotocin. At sacrifice after 4, 8 and 12 weeks, rats underwent either a 4 hour placebo or an intraperitoneal lipopolysaccharide (LPS, 2 mg/kg) challenge. Systolic blood pressure (SBP) and urinary protein excretion (UPE) increased significantly in diabetic (D) rats compared with C. The basal expression of glomerular iNOS mRNA was increased in D rats compared with that of C rats, by reverse- transcription (RT)-polymerase chain reaction (PCR), whereas there was no significant difference in the level of protein by Western blot analysis. Upon LPS stimulation, the iNOS mRNA and protein expression was significantly elevated in D rats. In D rats, this up-regulation, of LPS-stimulated iNOS expression, was equally ameliorated both by I and L in mRNA and protein levels. From immunohistochemistry (IHC), there was a negative staining for the iNOS within the glomeruli of five C rats without LPS treatment, but one of four rats, with LPS treatment, showed minimal iNOS staining in the glomeruli. In D rats, the glomerular mesangium and podocytes were positive for iNOS in each of three out of five rats with, and without, LPS treatment. In conclusion, LPS-stimulated glomerular iNOS expression was enhanced in diabetic pnephropathy, and the activation of angiotensin II may play a role in this enhancement.

Peritoneal Equilibration Test in Korean Patients Undergoing Continuous Ambulatory Peritoneal Dialysis / 대한신장학회잡지

In order to evaluate the peritoneal transport characteristics in Korean non-diabetic and diabetic end- stage renal disease patients, peritoneal equilibration test(PET) proposed by Twardowski et al. were performed on patients who had been on continuous ambulatory peritoneal dialysis(CAPD) for 2 to 6 months. The results were as follows : 1) Fifty four patients(including 24 diabetics) on CAPD were studied with a mean age of 48.7 years. And male/female ratio was 1 : 1.08. 2) In non-diabetics, the dialysate to dialysate prior to infusion ratio for glucose(D/D0 glu) at 2-, and 4-hour dwell times were 0.61+/-0.09, and 0.39+/-0.10, and the dialysate-to-plasma ratio for creatinine (D/P cr) at 2-, and 4-hour dwell times were 0.40+/-0.11, 0.63+/-0.12, respectively. 3) In diabetic patients, D/D0 glu at 2-, and 4- hour dwell times were 0.60+/-0.09, 0.39+/-0.08, respectively, and D/P cr at same dwell times were 0.50+/-0.08, and 0.71+/-0.08, which were significantly higher than in non-diabetics(por=150mg/dL) and normoglycemic(<150mg/ dL) patients. The values of D/Pcr at 2-, and 4-hour dwell times in hyper-glycemic patients were signficantly higher than in non-diabetic patients (D2/P2 cr : 0.50+/-0.09 vs. 0.40+/-0.11, D4/P4 cr : 0.72+/-0.07 vs 0.63+/-0.12, respectively, p<0.05). 5) Net ultrafiltration did not differ between any of subgroups. 6) In non-diabetic patients, the ranges of D4/P4 cr and D4/D0 glu for high, high average, low average, and low transporters were defined as D4/P4 cr : 0.87-0.75, 0.75-0.63, 0.63-0.51, 0.51-0.39, D4/D0 glu : 0.19-0.29 0.29-0.39, 0.39-0.49, 0.49-0.59, respectively, which were remarkably simliar as suggested by Twardowski et al. In conclusion, the creatinine and glucose transfers assessed by dialysate-plasma ratio of creatinine and glucose are remarkably similar between Korean and North American patients. And the creatinine transport rate in Korean diabetic patient is higher than non-diabetic patient while ultrafiltration is achievable in non-diabetic patient.