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In 2010, we proposed the first Korean Guidelines for the Prevention of Venous Thromboembolism (VTE). It was applicable to Korean patients, by modifying the contents of the second edition of the Japanese guidelines for the prevention of VTE and the 8th edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines. From 2007 to 2011, we conducted a nationwide study regarding the incidence of VTE after major surgery using the Health Insurance Review and Assessment Service (HIRA) database. In addition, we have considered the 9th edition of the ACCP Evidenced-Based Clinical Practice Guidelines, published in 2012. It emphasized the importance of clinically relevant events as opposed to asymptomatic outcomes with preferences for both thrombotic and bleeding outcomes. Thus, in the development of the new Korean guidelines, three major points were addressed: 1) the new guidelines stratify patients into 4 risk groups (very low, low, moderate, and high) according to the actual incidence of symptomatic VTE from the HIRA databases; 2) the recommended optimal VTE prophylaxis for each group was modified according to condition-specific thrombotic and bleeding risks; 3) guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and/or physician advice. Graphical Abstract

Background Venous thromboembolism (VTE) is a critical complication of malignant disease. Pancreatic cancer is one of the cancers most commonly associated VTE. In general, the VTE incidence rate of Asians is lower than that of Caucasians. In 2007, a Korean study reported that only four cases of VTE (5.3%) occurred in Seventy five patients with advanced pancreatic adenocarcinoma. We evaluated VTE incidence in pancreatic cancer and characteristics of pancreatic cancer patients with VTE. (We found out that VTE incidence rate among Asians was not lower, and the event of VTE was poor prognosis.) Method We retrospectively reviewed the medical records of patients with histopathologically proven pancreatic cancer from January 2006 to December 2012 at Soonchunhyang university hospital. We detected VTE through CT (chest CT, pulmonary embolism CT) and low extremity ultrasoundgraphy. Results Five hundred and fourteen patients with pancreatic adenocarcinoma were enrolled. (M: F, 300:214, localized: locally advanced: metastatic=31:230:253, mean age: 66.7 years). Ninety six of 514 patients (18.6%, symptomatic: aymptomatic=38:58, PE: DVT: PE+DVT: visceral thrombosis=20:19:19:38) were diagnosed as VTE. At the time of DVT diagnosis, cancer status of 50 patients cancer was progression, and that of 15 was stable. Thirty one patients were diagnosed with the pancreatic cancer and VTE, at the same time. They all had metastatic lesions. Fifty VTE patients were treated with antithrombotic therapy. Ninety three of 96 patients died, and three of them have probability that cause of death was VTE. The others died of pancreatic cancer progression. From pancreatic cancer diagnosis to VTE diagnosis, the period is 1.7month. (95%CI 1.1-2.3 month). Median overall survival (OS) was not significantly different between pancreatic cancer with VTE or without VTE. OS was significantly longer VTE patients after pancreatic cancer diagnosis than VTE patients with pancreatic cancer at the same time (10.73m vs. 1.7, p=0.00). Conclusion The incidence of VTE (18.6%) in Soonchunhyang university hospital with pancreatic cancer was not lower than that in western groups. Disclosures: No relevant conflicts of interest to declare.

All-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) combination yields a high quality remission and survival in newly diagnosed acute promyelocytic leukemia. For subsequent similar data, NCCN guidelines indicate that ATRA plus ATO is an alternative for patients who cannot tolerate anthracycline therapy. We demonstrated that SFK (Src Family Kinase) inhibitor PP2 enhanced acute promyelocytic leukemia (APL) cell differentiation when combined with either ATRA or ATO with difference in activation of RA-induced genes. In this study, we investigated SFK inhibitor PP2 could enhances the differentiation of NB4 APL cells when combined with ATRA and ATO and the changes in the expression of intercellular adhesion molecule-1 (ICAM-1) derived from the retinoic acid receptor (RAR) target gene. Treatment of NB4 cells with 1 nM of ATRA, 0.5 uM of ATO, or 10 uM of PP2 for 72 hours induced expression of CD11b-positive cells by 13.01%, 11.53% or 13.28%, respectively. However, the combination of ATRA and ATO and the combination of three agents (ATRA, ATO, and PP2) led to a significant higher expression of CD11b-positive cells (30.96% and 63.17%, respectively). The synergistic effect of the combination of three agents was more significant than the combination of ATRA and ATO. These results were confirmed by NBT staining. These effects were not related with apoptosis. Annexin-V-fluorescene staining revealed that combination of ATRA and ATO and combination of three agents did not induced apoptosis in NB4 cells. The expression of ICAM-1 was markedly increased in cells treated with the combination of three agents. These findings suggest that the SFK inhibitor can enhances differentiation of APL cells combined with ATRA and ATO. FDA approved SFK inhibitors, such as dasatinib and bosutinib, may be beneficial for the treatment of APL in combination with ATRA and ATO. Disclosures: No relevant conflicts of interest to declare.

Introduction Venous thromboembolism (VTE) is a major cause of morbidity and mortality after gynecologic and urologic surgeries and previously reported VTE incidence in major genitourinary surgery without VTE prophylaxis was 15-40% in Western countries. VTE is a preventable complication using thromboprophylaxis, however, pharmacologic thromboprophylaxis after major abdomino-pelvic surgery may involve serious bleeding complication. Here, we evaluated the exact incidence and risk factors of VTE following major genitourinary surgery in Korean patients and proposed evidence-based VTE prevention guidelines in such patients. Methods In March 2012, the committee for the development of guidelines for preventing VTE in Korea was organized by receiving recommendations from the VTE working party members in the Korean Society on Thrombosis and Hemostasis (KSTH). Using nation-wide date from Korea Health Insurance Review and Assessment Service (HIRA) from 2007 to 2011, symptomatic VTE frequencies after major genitourinary surgeries were retrospectively collected and evaluated. For the categorization of those patients by their VTE incidences, we used the methods described in AT9 guidelines (American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, 9th ed.) Results According to the HIRA database, 255,324 and 85,191 patients' data were collected and evaluated their incidence of VTE and risk factors, which underwent major gynecologic and urologic surgeries, respectively. In detail, there were 87,136 hysterectomies for benign uterine diseases (76,284) and uterine cervical cancer (10,852), 168,188 oophorectomies for benign ovarian diseases (156,697) and ovarian cancer (11,491), 35,970 prostatectomies for benign prostatic hyperplasia (BPH, transurethral, 26,590) and prostatic cancer (retropubic, 9,380), 12,462 nephrectomies for renal cell cancer and 36,759 radical cystectomies for bladder cancer. As shown in Table 1, most Korean patients undergoing genitourinary surgeries were identified as very low VTE risk category. In the aspect of gynecologic cancer surgery, ovarian cancer showed highest rate of VTE incidence (1.21%, moderate risk; 0.70% deep vein thrombosis, DVT + 0.51% pulmonary embolism, PE) and cervical cancer showed 0.59% (low risk; 0.47% DVT + 0.12% PE). On the basis of these data and a literature search results, the recommendation was made by a consensus of the guideline development committee. To take the advice of outside experts, survey and review for the developed guidelines were performed by other KSTH members and the related Academic Societies. Conclusions Even when considering relatively lower incidence of VTE in Asian people than that in Western, Korean genitourinary surgery patients revealed very low incidence of VTE. As stated above, abdomino-pelvic surgery is a procedure for high risk of bleeding complications. Therefore, it is reasonable to assume that the recommendation of pharmacologic thromboprophylaxis for other gynecologic surgeries except ovarian cancer surgery should be deferred until they reveal hard evidence of higher incidence of VTE in Korea. Disclosures: No relevant conflicts of interest to declare.

The characteristics of the tri-axial high temperature superconducting (HTS) power cable are different from a general copper cable, depending on whether the cable is under steady state or transient state, which is caused by quench. Before applying the tri-axial HTS power cable to a real utility, the system should be analyzed using certain simulation tools in order to confirm the effects of the cable on the real utility. However, a component that has the same impedance characteristics as the real tri-axial HTS power cable is not provided in simulation tools. In this paper, a model component for the tri-axial HTS power cable was developed in PSCAD/EMTDC. The developed model component included characteristics of the HTS cable, such as resistance, reactance, and temperature variation. The model component for the tri-axial HTS power cable was applied to a model power system and a simulation was performed under transient state. The simulation results show the effect of the tri-axial HTS power cable on the power system, the variation of quench resistance, and the temperature of the cable under fault conditions according to superconducting characteristics. The results of this work will be used to analyze the transient characteristics of other types of HTS power cables.

Correspondence to Jong Ho Won, M.D., Ph.D. Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea Tel: +82-2-709-9199, Fax: +82-2-797-1176, E-mail: jhwon@schmc.ac.kr Copyrightc 2013 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 비호지킨림프종 환자에서 자가조혈모세포이식 후 발생한 자가면역질환

Rectus sheath hematoma (RSH) is an uncommon condition caused by hemorrhage into the rectus sheath. RSH is characterized by abdominal pain and an abdominal mass. This condition is associated with old age, childbirth, abdominal surgery, severe coughing, severe sneezing, anticoagulation therapy, and/or coagulation disorders. We report herein a case of RSH and pelvic cavity hematoma that was induced by dalteparin injection in a 77-year-old woman with pulmonary embolism and deep vein thrombosis, and who was successfully treated by conservative management. (Korean J Med 2013;85:530-534)