Prediction of successful de-cannulation of tracheostomised patients in medical intensive care units.

BACKGROUND: Limited data are available on practical predictors of successful de-cannulation among the patients who undergo tracheostomies. We evaluated factors associated with failed de-cannulations to develop a prediction model that could be easily be used at the time of weaning from MV. METHODS: In a retrospective cohort of 346 tracheostomised patients managed by a standardized de-cannulation program, multivariable logistic regression analysis identified variables that were independently associated with failed de-cannulation. Based on the logistic regression analysis, the new predictive scoring system for successful de-cannulation, referred to as the DECAN score, was developed and then internally validated. RESULTS: The model included age > 67 years, body mass index < 22 kg/m2, underlying malignancy, non-respiratory causes of mechanical ventilation (MV), presence of neurologic disease, vasopressor requirement, and presence of post-tracheostomy pneumonia, presence of delirium. The DECAN score was associated with good calibration (goodness-of-fit, 0.6477) and discrimination outcomes (area under the receiver operating characteristic curve 0.890, 95% CI 0.853-0.921). The optimal cut-off point for the DECAN score for the prediction of the successful de-cannulation was ≤ 5 points, and was associated with the specificities of 84.6% (95% CI 77.7-90.0) and sensitivities of 80.2% (95% CI 73.9-85.5). CONCLUSIONS: The DECAN score for tracheostomised patients who are successfully weaned from prolonged MV can be computed at the time of weaning to assess the probability of de-cannulation based on readily available variables.

Fat quantification of multifidus muscle using T2-weighted Dixon: which measurement methods are best suited for revealing the relationship between fat infiltration and herniated nucleus pulposus.

OBJECTIVE: To reveal the best-suited method for fat quantification of lumbar multifidus to demonstrate its relationship to herniated nucleus pulposus (HNP) using T2-weighted Dixon. MATERIALS AND METHODS: One hundred eight patients who underwent MRI for low back pain were enrolled. Two readers independently analyzed the fat fraction (Ff) using axial two-dimensional (D), coronal 2-D, and coronal 3-D measurement. Pearson's correlation coefficient was calculated between age, body mass index (BMI), and the Ff, and age, sex, BMI, and Ff were compared between 'HNP group' and 'no HNP group'. Multivariate logistic regression analysis was performed to identify factors associated with HNP. RESULTS: Coronal 2-D Ff showed the highest correlation with age (r = 0.536, P < 0.001). Coronal 2-D Ff, and coronal 3-D Ff were significantly higher in those with HNP (coronal 2-D: 18.9 ± 2.9, coronal 3-D: 19.7 ± 2.6, respectively) than those without HNP (coronal 2-D: 17.2 ± 3.2, coronal 3-D: 17.4 ± 3.2, respectively). Ff of all three measurements were significantly higher in those with HNP ≥ 3 levels (axial 2-D: 20.7 ± 3.0, coronal 2-D: 21.1 ± 2.7, coronal 3-D: 21.6 ± 2.5, respectively) than those with HNP <3 levels (axial 2-D: 17.5 ± 4.3, coronal 2-D: 18.5 ± 2.7, coronal 3-D: 19.3 ± 2.5). The BMI was an independent predisposing factor to HNP (P = 0.011). Age and coronal 2-D Ff were significant predictors for multilevel HNP (P = 0.028 and 0.040, respectively). CONCLUSIONS: The Ff of the multifidus muscle on T2-weighted Dixon was associated with age, sex, and HNP. The coronal 2-D measurement was the best suited for fat quantification in multifidus muscle among three measurement methods.

MR cholangiography in potential liver donors: quantitative and qualitative improvement with administration of an oral effervescent agent.

PURPOSE: To determine whether an oral effervescent agent improves magnetic resonance cholangiography (MRC) images, both qualitatively and quantitatively, in potential live liver donors. MATERIALS AND METHODS: This retrospective study was approved by the Institutional Review Board, and informed consent was waived. Seventy potential liver donors underwent 2D MRC before and after administration of an oral effervescent agent. One radiologist measured relative contrast ratio (rC) and relative signal intensity (rS) for right and left intrahepatic ducts (RHD and LHD), and common hepatic duct (CHD). After assessment of overall image quality, two other radiologists independently scored visualization of five ductal segments (RHD, LHD, CHD, cystic, and common bile duct) and assessed the preferred image set. In consensus, they assessed the biliary anatomy. The data were analyzed using a paired t-test, Wilcoxon's signed-rank test, and chi-square test. RESULTS: Both rC and rS of RHD and CHD were significantly higher on MRC images after administration of an oral effervescent agent than before (P < 0.03). The overall image quality grades and biliary visualization scores for all five duct segments were significantly higher on MRC images after administration of an oral effervescent agent than before (P < 0.0001). Between these images, both readers more often preferred MRC images with an effervescent agent rather than those without this agent (reader 1: 56/70, 80.0%; reader 2: 55/70, 78.6%; P = 0.0003). The readers correctly assessed second-order biliary tract anatomy in two more subjects on MRC after administration of an effervescent agent than before. CONCLUSION: Oral administration of an effervescent agent improves MRC images, both qualitatively and quantitatively, in live liver donors. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1656-1663.

Monitoring of Potential Safety Events and Vital Signs during Active Mobilization of Patients Undergoing Continuous Renal Replacement Therapy in a Medical Intensive Care Unit.

BACKGROUND/AIMS: This study aims to evaluate potential safety events and vital sign changes during active mobilization physical therapy (PT) in critically ill patients undergoing continuous renal replacement therapy (CRRT). METHODS: A retrospective review was performed on 29 patients who were treated with CRRT and who underwent 81 PT sessions in a medical intensive care unit at a single referral hospital; 15 patients underwent 33 sessions with passive range of motion (PROM) and 17 patients underwent 48 active mobilization PT sessions. Three patients received both types of PT including 8 PROM and 5 active mobilization PT sessions. The occurrences of safety events and vital sign changes during active mobilization PT sessions were evaluated. RESULTS: The safety events did not develop during 33 sessions with PROM. However, there were 2 safety events (4.1%) during 48 active mobilization PT sessions including one session with mobilization in the bed and the other in a sitting position on the edge of the bed. These safety events exclusively developed during active mobilization PT sessions, in which concomitant extracorporeal membrane oxygenation (ECMO) support and CRRT were delivered. Regarding vital sign changes during PT sessions, there were no significant differences in systolic blood pressure (BP), diastolic BP, mean arterial pressure, heart rate, respiratory rate, or peripheral oxygen saturation before and after both PROM and active mobilization PT sessions. CONCLUSIONS: This study showed that active mobilization PT can be performed safely in patients who are being treated with CRRT without a significant hemodynamic change. However, the development of potential safety events in patients with ECMO needs to be monitored carefully.

Safety and Efficacy of Radiofrequency Ablation for Hepatic Metastases from Gastrointestinal Stromal Tumor.

PURPOSE: To evaluate the safety and efficacy of radiofrequency (RF) ablation for hepatic metastases from gastrointestinal stromal tumor (GIST). MATERIALS AND METHODS: Retrospective review of a prospectively maintained database was performed between February 2002 and November 2010 and identified 29 patients with GISTs (18 male; age range, 35­77 y; median age, 61 y) who had undergone ultrasound-guided RF ablation for metastases detected in the liver. All patients had been treated with imatinib mesylate. Indications for RF ablation were tumor progression during medical therapy or the development of drug resistance after initial tumor control. The average number of target lesions per procedure was 2.3 (range, 1­8), and mean lesion diameter was 1.3 cm (range, 0.4­3.6 cm). RESULTS: For 69 lesions among 86 hepatic metastases, RF ablation was successfully performed according to the protocol currently in use. In 17 hepatic metastases in 13 patients, RF ablation was not performed because of poor lesion visibility or possible thermal damage to adjacent organs. Major complications included bleeding at the ablation site in one patient and peritoneal seeding near the ablation tract in another patient. Technical effectiveness was achieved for 66 of 69 lesions (95.6%). The median follow-up period was 33.1 months (range, 12.3­108.6 mo). Four of 66 lesions (6%) showed local recurrence at 3.2­10.5 months. Four patients died of disease progression. The median overall survival period was 90.2 months (range, 12.3­108.6 mo). CONCLUSIONS: RF ablation appears to be a safe and effective treatment for hepatic metastases of GIST when medical therapy fails.

Independent risk factors for mortality in patients with chronic obstructive pulmonary disease who undergo comprehensive cardiac evaluations.

BACKGROUND: Cardiovascular disease is the most common cause of death in chronic obstructive pulmonary disease (COPD). However, the impact of cardiovascular comorbidities on the prognosis of COPD is not well known. OBJECTIVES: This study was performed to investigate the effects of cardiovascular comorbidities on the prognosis of COPD. METHODS: We enlisted 229 patients with COPD who underwent comprehensive cardiac evaluations including coronary angiography and echocardiography at Ajou University Hospital between January 2000 and December 2012. Survival analyses were performed in this retrospective cohort. RESULTS: Kaplan-Meier analyses showed that COPD patients without left heart failure (mean survival = 12.5 ± 0.7 years) survived longer than COPD patients with left heart failure (mean survival = 6.7 ± 1.4 years; p = 0.003), and the survival period of nonanemic COPD patients (mean survival = 13.8 ± 0.8 years) was longer than that of anemic COPD patients (mean survival = 8.3 ± 0.8 years; p < 0.001). The survival period in COPD with coronary artery disease (CAD; mean survival = 11.37 ± 0.64 years) was not different from that in COPD without CAD (mean survival = 11.98 ± 0.98 years; p = 0.703). According to a multivariate Cox regression model, a lower hemoglobin level, a lower left ventricular ejection fraction, and the forced expiratory volume in 1 s (FEV1) were independently associated with higher mortality in the total COPD group (p < 0.05). CONCLUSIONS: Hemoglobin levels and left ventricular ejection fraction along with a lower FEV1 were identified as independent risk factors for mortality in COPD patients who underwent comprehensive cardiac evaluations, suggesting that multidisciplinary approaches are required in the care of COPD.

Characterization of putative glycosylphosphatidylinositol-anchoring motifs for surface display in the methylotrophic yeast Hansenula polymorpha.

Bioinformatic analysis of the genome of the methylotrophic yeast Hansenula polymorpha revealed 39 putative glycosylphosphatidylinositol-anchored proteins (GPI-proteins). Notably, dibasic motifs in the proximal ω-site, that has been reported as a plasma membrane retention signal in Saccharomyces cerevisiae GPI-proteins, were not found in any of the predicted GPI-proteins of H. polymorpha. To evaluate the in silico prediction, C-terminal peptides of 40 amino acids derived from ten H. polymorpha GPI-proteins were fused to the Aspergillus saitoi α-1,2-mannosidase (msdS). Cell wall fraction analysis showed that nine of the ten msdS-GPI fusion proteins were mostly localized at the cell wall. Surface expression of functional msdS was further confirmed by in vitro enzyme activity assay and by glycan structure analysis of cell wall mannoproteins. The recombinant H. polymorpha strains expressing surface-displayed msdS have the potential as useful hosts to produce glycoproteins with decreased mannosylation.

Quantitative risk factor analysis of prior disease condition and socioeconomic status with the multiple myeloma development: nationwide cohort study.

Early diagnosis and following management are important determinants of the prognosis of multiple myeloma (MM). However, screening for MM is not routinely performed because it is rare disease. In this study, we evaluated the association of prior disease condition and socioeconomic status (SES) with MM diagnosis and developed a simple predictive model that can identify patients at high risk of developing MM who may need screening using nationwide database from South Korea. According to multivariate logistic regression analysis, eight prior disease conditions and SES before diagnosis were shown to be predictors of MM development and selected for score development. Total prediction scores were categorized into four groups: patients without any risk (≤ 0) intermediate-1 (0.5-9), intermediate-2 (9-14), and high risk (> 14). The odds ratios for developing MM in the intermediate-1, intermediate-2, and high-risk groups were 1.29, 3.07, and 4.62, respectively. The association of prior disease conditions and SES with MM diagnosis were demonstrated and the simple scoring system to predict the MM risk was developed. This scoring system is also provided by web-based application and could be a useful tool to support clinicians in identifying potential candidates for MM screening.

High-speed RNA microextraction technology using magnetic oligo-dT beads and lateral magnetophoresis.

This paper presents a high-speed RNA microextractor for the direct isolation of RNA from peripheral blood lysate using magnetic oligo-dT beads. The extraction is achieved through lateral magnetophoresis, generated by a ferromagnetic wire array inlaid on a glass substrate. This RNA microextractor separated more than 80% of magnetic beads with a flow rate up to 20 ml h(-1), and the overall extraction procedure was completed within 1 min. The absorbance ratio of RNA to protein (A(260)/A(280)) was >1.7, indicating that the extraction technology yielded nearly pure RNA. The feasibility of this technique was evaluated further for its applicability to reverse transcription polymerase chain reaction (RT-PCR) procedures by performing cDNA synthesis and PCR. The analysis verified that the RNA microextractor is a practical method for easy, rapid, and high-precision RT-PCR using minimal reagent volumes without requiring highly trained personnel. In addition, it can be readily incorporated into genetic analysis procedures for realizing automated on-chip genetic platforms in a micro format.

Magnetic Resonance Enterography and Capsule Endoscopy in Patients Undergoing Patency Capsule for the Evaluation of Small Bowel Crohn's Disease: A Korean Clinical Experience.

OBJECTIVE: Studies comparing magnetic resonance enterography (MRE) and capsule endoscopy (CE) for the assessment of small bowel (SB) Crohn's disease (CD) are scarce in Korea. In addition, there is no Korean experience of patency capsule (PC) examination prior to CE. The primary aim of this study was to compare diagnostic yields of MRE and CE for the assessment of SB CD. Secondary objectives were to compare the detection rate of proximal SB lesions by each modality in the Montreal classification and evaluate the safety and feasibility of PC in Korean CD patients. METHODS: MRE was performed as the first examination to assess SB CD. PC examination and CE were then performed. Diagnostic yields of active SB disease by MRE and CE were then analyzed. RESULTS: Disintegration of the patency capsule was shown in 5 patients out of 26 patients, who did not undergo CE. These 5 patients were accounted as negative CE findings. Overall, MRE and CE detected 80.8% and 65.4% of active SB lesions of CD in 26 patients, respectively (P = 0.212). MRE and CE detected 0% (0/26) and 19.2% (5/26) (P = 0.051) of jejunal lesions, 30.8% (8/26) and 42.3% (11/26) (P = 0.388) of proximal ileal lesions, and 80.8% (21/26) and 53.8% (14/26) (P = 0.039) of terminal ileal lesions, respectively. According to the Montreal classification, MRE and CE independently detected proximal disease (L4) in 30.8% (8/26) and 53.8% (14/26) (P = 0.092), respectively. CONCLUSIONS: The diagnostic yields of MRE and CE for the assessment of SB CD including proximal SB lesions were similar. MRE is a more objective tool for detecting clinically relevant stricture than PC although PC examination could be performed safely before CE to prove the patency of SB. This trial is registered with KCT0004305.

High-throughput quantitative analysis of plant N-glycan using a DNA sequencer.

High-throughput quantitative analytical method for plant N-glycan has been developed. All steps, including peptide N-glycosidase (PNGase) A treatment, glycan preparation, and exoglycosidase digestion, were optimized for high-throughput applications using 96-well format procedures and automatic analysis on a DNA sequencer. The glycans of horseradish peroxidase with plant-specific core alpha(1,3)-fucose can be distinguished by the comparison of the glycan profiles obtained via PNGase A and F treatments. The peaks of the glycans with (91%) and without (1.2%) alpha(1,3)-fucose could be readily quantified and shown to harbor bisecting beta(1,2)-xylose via simultaneous treatment with alpha(1,3)-mannosidase and beta(1,2)-xylosidase. This optimized method was successfully applied to analyze N-glycans of plant-expressed recombinant antibody, which was engineered to contain a minor amount of glycan harboring beta(1,2)-xylose. These results indicate that our DNA sequencer-based method provides quantitative information for plant-specific N-glycan analysis in a high-throughput manner, which has not previously been achieved by glycan profiling based on mass spectrometry.

Initial base deficit as predictors for mortality and transfusion requirement in the severe pediatric trauma except brain injury.

OBJECTIVE: The initial base deficit (BD) is an important indicator of shock in adult trauma patients, but its value is unclear in pediatric trauma patients. This study assessed the ability of the initial BD to predict mortality and blood transfusion requirements in children except severe brain injury patients. METHODS: This study was a retrospective review of pediatric patients with severe trauma arriving at the emergency department of a university hospital from January 1998 to June 2005. Blood pressure, the initial BD, and the Injury Severity Score were assessed as independent predictors of mortality and the blood transfusion requirement using multiple regression analysis. RESULTS: The study group constituted 102 patients. According to the multiple regression analysis results, the initial systolic blood pressure, Injury Severity Score, and blood transfusion requirement were not independent predictors of mortality (P = 0.104, 0.959, 0.386, respectively). By contrast, the initial BD was an independent predictor, with an odds ratio of 13.6 for BD of -8 mEq/L or less (confidence interval [CI], 3.51-35.23, P = 0.037), and systolic blood pressure and BD were independent predictors of blood transfusion requirement; the odds ratio for hypotension was 3.2 (CI, 0.51-8.32, P = 0.044), and the odds ratio was 15.3 for BD values of -8 or less (CI, 2.24-51.43, P = 0.003). CONCLUSION: The initial BD in pediatric trauma patients except severe brain injury was an independent predictor of mortality and blood transfusion requirement within 24 hours. Mortality and blood transfusion requirement were significantly high when initial BD was less than -8 mEq/L.

A case of hemoperfusion and L-carnitine management in valproic acid overdose.

Valproic acid (VPA) is used to manage a variety of conditions, including simple and complex absence seizure disorder, bipolar disorder, and migraine prophylaxis. The clinical manifestations of VPA overdose range in severity from mild confusion and lethargy to severe coma and death. The treatment of VPA toxicity is mainly supportive. There is no specific antidote or guidelines for managing VPA intoxication. Anecdotal reports describe the efficacy of naloxone and L-carnitine, but the data are insufficient to make strong conclusions. Various extracorporeal techniques for managing VPA toxicity have been described, but none has prevailed as standard therapy. We report a patient with VPA overdose who was treated successfully with hemoperfusion with activated charcoal and L-carnitine. The VPA level of the patient exceeded 1000 microg/mL and was normalized after 3 rounds of hemoperfusion. The patient was injected with L-carnitine at a maximum of 600 mg/kg per day for 5 days without complications.

Stress and cigarette smoking in Korean men with diabetes.

The purpose of the study was to investigate the level of stress and cigarette smoking behaviors in Korean men with diabetes and to exam the relationships among them. Data were collected using the questionnaire including background characteristics, modified Brief Encounter Psychosocial Instrument (BEPSI) and the Fagerstrom Tolerance Questionnaire (FTQ). 37% of the participants were current smokers with a mean of 4.22 FTQ score. 22% among the current smokers had a nicotine dependency. 43.1% indicated they were considering quitting smoking within 6 months. The level of stress was not associated with the amount of smoking. However, the level of stress was associated with nicotine dependency. There were no significant differences between the smoking cessation stage and stress. In conclusion, the prevalence of smoking among Korean men with diabetes is high. The large proportion of smokers in the contemplation and preparation stages should be supported by the need for stage-matched interventions targeting this special group of smokers.

Orally Available Collagen Tripeptide: Enzymatic Stability, Intestinal Permeability, and Absorption of Gly-Pro-Hyp and Pro-Hyp.

Collagen-derived small peptides, such as Gly-Pro-Hyp (GPH) and Pro-Hyp (PH), play a role in various physiological functions. Although collagen degrades in the gastrointestinal tract randomly and easily, it is not readily cleaved into bioactive peptides. To increase the bioavailability of bioactive peptides, a collagen tripeptide (CTP) was prepared from fish scales by the digestion method using collagenase from nonpathogenic Bacillus bacteria. It was demonstrated that Hyp-containing peptides-GPH and PH-were better absorbed and reached higher plasma levels after the oral administration of CTPs in rats compared to high molecular weight collagen peptide (H-CP). GPH and PH were stable in gastrointestinal fluid and rat plasma for 2 h, and GPH was able to be transported across the intestinal cell monolayer. These results suggest that the ingestion of CTP is an efficient method for taking bioactive peptides orally due to the enzymatic stability and intestinal permeability of GPH and PH.

Expression and purification of FGF21 in Pichia pastoris and its effect on fibroblast-cell migration.

Fibroblast growth factor (FGF)21 functions in the maintenance of glucose homeostasis and exerts protective effects on the liver, heat and kidneys. However, the roles of FGF21 in other tissue types are yet to be fully elucidated. The present study detected elevated expression levels of FGF21 in skin tissue. Furthermore, it was revealed that FGF21 expression in the skin was induced upon wounding. In addition, ß­klotho expression was detected in the skin tissue. To examine the role of FGF21 in the wound healing process, recombinant human (h)FGF21 was expressed in a the yeast strain Pichia (P.) pastoris, a well­known system for recombinant protein production. Based on the sequence of hFGF21 and the optimal codon of P. pastoris, codon­optimized FGF21 open reading frame sequences were obtained using seven pairs of 55­59­nt primers with seven rounds of PCR. The recombinant FGF21 was purified and its function was examined in human fibroblast cells using a wound healing cell migration assay. Treatment with FGF21 promoted cell migration, which is an important step in wound healing. Furthermore, FGF21 treatment enhanced the activity of c­Jun N­terminal kinase, a key regulator in fibroblast­cell migration. In conclusion, FGF21 is induced after wounding and FGF21 expressed and purified from yeast markedly accelerates wound healing. The present study was the first to elucidate the function of FGF21 in skin tissues and provided a theoretical basis for the use of FGF21 in the treatment of skin wounds.

Noninvasive quantitative estimation of hepatic steatosis by ultrasound: a comparison of the hepato-renal index and ultrasound attenuation index.

AIMS: To compare the accuracy of the ultrasound attenuation index (USAI) and hepato-renal index (HRI) for the diagnosis of hepatic steatosis (HS). MATERIAL AND METHODS: Two hundred and twenty-four potential living hepatic donors underwent US and subsequent US-guided liver biopsy. The USAI was calculated from US images with an 8 MHz transducer and HRI was measured on sagittal images with a clear visualization of both the liver and kidney. Using histological degrees of HS as the reference standard, we compared the performance of USAI and HRI for diagnosing HS ≥ 5% and ≥ 30% by receiver operating characteristic curve analysis. The interobserver agreement was evaluated by using intraclass correlation coefficients (ICCs) or Bland-Altman statistics. RESULTS: Histologic degree of HS was 0-70% (median, 5%). HRI showed a tendency towards higher accuracy than USAI for diagnosing HS ≥ 5% (the area under the ROC curve, 0.856 vs. 0.820; p= 0.279) and ≥ 30% (0.937 vs. 0.909; p = 0.378) without statistical significance. There was an excellent interobserver agreement for both USAI and HRI (ICC = 0.931 and 0.973, respectively). According to the Bland-Altman method, the 95% limits of difference between two readers for HS were -8.5% to 6.6% by USAI and -4.8% to 6.2% by HRI. Most patients would have the difference of calculated HS by USAI (74.0%) and HRI (96.0%) from different operators within a range of ±5%. CONCLUSIONS: Although statistically insignificant, HRI was superior to USAI for the diagnosis and quantitative estimation of HS in terms of diagnostic performance, including accuracy and reproducibility.

Visceral Obesity Is Associated with Gallbladder Polyps.

BACKGROUND/AIMS: Gallbladder polyps (GBP) are a common clinical finding and may possess malignant potential. We conducted this study to determine whether visceral obesity is a risk factor for GBP. METHODS: We retrospectively reviewed records of subjects who received both ultrasonography and computed tomography with measurements of the areas of visceral adipose tissue and total adipose tissue (TAT) on the same day as health checkups. RESULTS: Ninety-three of 1,615 subjects (5.8%) had GBP and were compared with 186 age- and sex-matched controls. VAT (odds ratio [OR], 2.941; 95% confidence interval [CI], 1.325 to 6.529; p=0.008 for the highest quartile vs. the lowest quartile) and TAT (OR, 3.568; 95% CI, 1.625 to 7.833; p=0.002 for the highest quartile vs. the lowest quartile) were independent risk factors together with hypertension (OR, 2.512; 95% CI, 1.381 to 4.569; p=0.003), diabetes mellitus (OR, 2.942; 95% CI, 1.061 to 8.158; p=0.038), hepatitis B virus positivity (OR, 3.548; 95% CI, 1.295 to 9.716; p=0.014), and a higher level of total cholesterol (OR, 2.232; 95% CI, 1.043 to 4.778; p=0.039 for. CONCLUSIONS: Visceral obesity measured by VAT and TAT was associated with GBP irrespective of body mass index or waist circumference.

Thrombocytopenia in Systemic Lupus Erythematosus: Clinical Manifestations, Treatment, and Prognosis in 230 Patients.

The aim of the study was to examine the clinical characteristics and prognosis according to severity of thrombocytopenia and response to treatment for thrombocytopenia in patients with systemic lupus erythematosus (SLE).We retrospectively evaluated 230 SLE patients with thrombocytopenia, and reviewed their clinical data and laboratory findings. Thrombocytopenia was defined as platelet counts under 100,000/mm, and patients were divided into 3 thrombocytopenia groups according to severity: mild (platelet counts >50,000/mm), moderate (>20,000/mm, ≤50,000/mm), and severe (≤20,000/mm). Clinical characteristics, treatments, and prognoses were compared among the groups. Furthermore, complete remission of thrombocytopenia was defined as platelet counts >100,000/mm after treatment.There was no significant difference in clinical or laboratory findings among the groups according to severity of thrombocytopenia. However, hemorrhagic complications were more frequent in severe thrombocytopenia (P < 0.001) and mortality was also higher (P = 0.001). Complete remission was achieved in 85.2% of patients. The clinical characteristics and modality of treatment did not differ between the patients with and without complete remission. Mortality in patients with complete remission (1.5%) was significantly lower than in those without complete remission (29.4%, P < 0.001). Survival was significantly higher in patients with complete remission from thrombocytopenia (odds ratio = 0.049, 95% confidence interval: 0.013-0.191, P < 0.001).The severity of thrombocytopenia in SLE patients can be a useful independent prognostic factor to predict survival. Moreover, complete remission of thrombocytopenia after treatment is an important prognostic factor. The severity of thrombocytopenia and response to treatment should be closely monitored to predict prognosis in SLE patients.

Can stone density on plain radiography predict the outcome of extracorporeal shockwave lithotripsy for ureteral stones?

PURPOSE: The objective was to determine whether stone density on plain radiography (kidney-ureter-bladder, KUB) could predict the outcome of extracorporeal shockwave lithotripsy (ESWL) for ureteral stones. MATERIALS AND METHODS: A total of 223 patients treated by ESWL for radio-opaque ureteral stones of 5 to 20 mm were included in this retrospective study. All patients underwent routine blood and urine analyses, plain radiography (KUB), and noncontrast computed tomography (NCCT) before ESWL. Demographic, stone, and radiological characteristics on KUB and NCCT were analyzed. The patients were categorized into two groups: lower-density (LD) group (radiodensity less than or equal to that of the 12th rib, n=163) and higher-density (HD) group (radiodensity greater than that of the 12th rib, n=60). Stone-free status was assessed by KUB every week after ESWL. A successful outcome was defined as stone free within 1 month after ESWL. RESULTS: Mean stone size in the LD group was significantly smaller than that in the HD group (7.5±1.4 mm compared with 9.9±2.9 mm, p=0.002). The overall success rates in the LD and HD groups were 82.1% and 60.0%, respectively (p=0.007). The mean duration of stone-free status and average number of SWL sessions required for success in the two groups were 21.7 compared with 39.2 days and 1.8 compared with 2.3, respectively (p<0.05). On multivariate logistic analysis, stone size and time to ESWL since colic and radiodensity of the stone on KUB were independent predictors of successful ESWL. CONCLUSIONS: Our data suggest that larger stone size, longer time to ESWL, and ureteral stones with a radiodensity greater than that of the 12th rib may be at a relatively higher risk of ESWL failure 1 month after the procedure.