Search

We have developed a colorimetric biosensing system for the detection of antibody against MPT64, a protein secreted by Mycobacterium tuberculosis, using aptamer DNA adsorbed Fe₃O₄ magnetic nanoparticles (MNPs) for diagnosis of tuberculosis (TB). In this system, MNPs were first incubated with single stranded (ss) DNA-type aptamer having a high affinity toward target antibody against MPT64 (anti-MPT64), resulting in quick inhibition of the peroxidase-like activity of MNPs via the adsorption of aptamer on the surface of MNPs. By the addition of sample solutions containing anti-MPT64, aptamer bound on the surface of MNPs would strongly interact with free anti-MPT64 and be detached from the MNPs, thereby increasing the available surface area of the MNPs and consequently yielding enhanced peroxidase activity. Using this strategy, target anti-MPT64 was successfully detected by displaying increased colorimetric intensities from the higher oxidation of employed peroxidase substrate, 2,2'-azino-bis(3-ethylbenzo-thiazoline-6-sulfonic acid) (ABTS). Based on these results, we anticipate that aptamer adsorbed MNPs can serve as a potent probe system for the detection of clinically important target molecules.

AIM Group B streptococcus (GBS) is a leading cause of life-threatening bacterial infections among newborns, and neonates born to heavily colonized women may be subject to vertical transmission. We sought to determine an appropriate detection method for genital GBS in pregnant women by comparing culture-based methods and real-time polymerase chain reaction (PCR). In addition, we performed molecular serotyping and multilocus sequence typing (MLST) on isolates. METHODS A total of 150 pregnant women were enrolled and underwent vaginal-rectal swabbing at 16-40 weeks of gestation. GBS was identified by conventional culture and real-time PCR with or without enrichment. Molecular serotyping and MLST were performed on isolates. RESULTS Overall genital GBS positive rate among the 150 study subjects was 17.3%. Direct culture identified 18 (12.0%) positive specimens, enrichment culture 22 (14.6%), direct PCR 24 (16.0%) and enrichment PCR 25 (16.6%). The sensitivity and specificity by direct and enrichment PCR were as follows: for direct PCR, 90.9% and 96.9%, respectively; and for enrichment PCR, 95.5% and 96.9%, respectively. Resistance rates to clindamycin and erythromycin were 33.3% and 19.1%, respectively. Serotype III-1 was the most common (26.3%), followed by serotype Ib (21.1%), III-3 (15.8%), V (15.8%), II (10.5%), IV (5.3%) and VI (5.3%). Most common sequence types (ST) were ST-1, ST-19 and ST-862 (15.8%), followed by ST-2 and ST-654 (10.5%). CONCLUSION Direct real-time PCR using vaginal-rectal specimen could be used for detecting GBS in emergent conditions. Molecular serotypes III, Ib and V were most common. MLST analysis frequently presented ST-1, ST-19 and ST-862.

Background Rapid and accurate diagnosis of acute myocardial infarction (AMI) is critical for initiating effective treatment and achieving better prognosis. We investigated the performance of copeptin for early diagnosis of AMI, in comparison with creatine kinase myocardial band (CK-MB) and troponin I (TnI). Methods We prospectively enrolled 271 patients presenting with chest pain (within six hours of onset), suggestive of acute coronary syndrome, at an emergency department (ED). Serum CK-MB, TnI, and copeptin levels were measured. The diagnostic performance of CK-MB, TnI, and copeptin, alone and in combination, for AMI was assessed by ROC curve analysis by comparing the area under the curve (AUC). Sensitivity, specificity, negative predictive value, and positive predictive value of each marker were obtained, and the characteristics of each marker were analyzed. Results The patients were diagnosed as having ST elevation myocardial infarction (STEMI; N=43), non-ST elevation myocardial infarction (NSTEMI; N=25), unstable angina (N=78), or other diseases (N=125). AUC comparisons showed copeptin had significantly better diagnostic performance than TnI in patients with chest pain within two hours of onset (AMI: P=0.022, ≤1 hour; STEMI: P=0.017, ≤1 hour and P=0.010, ≤2 hours). In addition, TnI and copeptin in combination exhibited significantly better diagnostic performance than CK-MB plus TnI in AMI and STEMI patients. Conclusions The combination of TnI and copeptin improves AMI diagnostic performance in patients with early-onset chest pain in an ED setting.

Background Apixaban and rivaroxaban are approved for the prevention and treatment of deep vein thrombosis (DVT), pulmonary embolism (PE), and embolic stroke in atrial fibrillation (AF) patients. The aim of this study was to find appropriate methods of monitoring the anticoagulant effects of are direct oral anticoagulants (DOACs) and establish on-therapy ranges using conventional tests. Methods A total of 184 samples were collected from 91 patients receiving DOACs. Concentrations of apixaban and rivaroxaban in plasma were accessed by an anti-factor Xa chromogenic assay. PT, APTT, antithrombin, D-dimer, dRVVT screen/confirm, FDP, and fibrinogen levels were measured. On-therapy ranges were calculated by substituting previously reported trough plasma concentrations of DOACs. Results Anti-factor Xa chromogenic assay-based DOACs levels were 26.0-279.5 (115.9 ± 56.5) ng/mL for apixaban at 2.5 mg BID, 19.9-565.1 (205.3 ± 162.4) ng/mL for apixaban at 5 mg BID, 2.3-395.3 (205.3 ± 162.4) ng/mL for rivaroxaban at 15 mg OD, 3.6-494.8 (119.6 ± 95.1) ng/mL for rivaroxaban at 20 mg OD, and 9.6-431.4 (140.8 ± 113.6) ng/mL for rivaroxaban at 15 mg BID. PT (%), antithrombin, and dRVVT confirm tests showed good correlation with plasma apixaban levels. Plasma rivaroxaban concentrations were correlated well with PT (sec), PT (%),and dRVVT confirm results. On-therapy ranges established for dRVVT confirm test by linear regression were as follows: 1.32-1.52 for apixaban 2.5 mg BID, 1.12-1.75 for apixaban 5 mg BID, 1.11-1.78 for rivaroxaban 15 mg OD, 1.09-1.64 for rivaroxaban 20 mg OD, and 1.22-1.81 for rivaroxaban 20 mg BID. Conclusions Apixaban concentrations were well correlated with PT (%), antithrombin, and dRVVT confirm test. Rivaroxaban concentrations showed good correlation with PT (sec), PT (%), and dRVVT confirm test.

This study was to determine the relationship between pbp3 and pbp4 gene compared with mecA and TEM resistance genes expression patterns. Total 134 clinical S. aureus strains were subjected to 19 antimicrobial susceptibility tests. We detected resistance to methicillin (mecA), penicillin (blaTEM) and expression of pbp (Penicillin-binding proteins) genes. We were compared blaTEM, extended spectrum, carbapenem related genes and types of SCCmec identified. Total of 134 clinical S. aureus strains, 79 (58.96%) in methicillin resistance, and 77 strains carried mecA. Prevalence rates of blaTEM and pbp genes were 107/134 (79.85%) and 128/134 (95.52%). Multiplex PCR results revealed that the predominant SCCmec type among 77 mecA-positive MRSA strains were similer too SCCmec type II 41.56% (32/77) and type IVA 40.26% (31/77). Prevalence rates of type IVb, IVd and non-typable were 18.18% (14/77), respectively. From a total of 77/134 (57.46%) MRSA isolate strains, 35/77 (45.46%) were positive for extended spectrum, 40/77 (51.95%) for cephalosporins, and 35/77 (45.46%) for carbapenems. The predominant SCCmec type II had more carbapenem resistances than IVA, IVb and IVd. TEM and mecA gene expression were not correlated with pbp gene, and the properties of drug resistance were appeared not associated with pbp3, 4 genes.

Actinomyces meyeri is a Gram positive, strict anaerobic bacterium, which was first described by Meyer in 1911. Primary actinomycotic osteomyelitis is rare and primarily affects the cervicofacial region, including mandible. We present an unusual case of osteomyelitis of a long bone combined with myoabscess due to A. meyeri. A 70-year-old man was admitted for pain and pus discharge of the right elbow. Twenty-five days before admission, he had hit his elbow against a table. MRI of the elbow showed a partial tear of the distal triceps tendon and myositis. He underwent open debridement and partial bone resection for the osteomyelitis of the olecranon. Biopsy showed no sulfur granules, but acute and chronic osteomyelitis. The excised tissue grew A. meyeri and Peptoniphilus asaccharolyticus. Intravenous ceftriaxone was administered and switched to oral amoxicillin. Infection of the extremities of actinomycosis often poses diagnostic difficulties, but it should not be neglected even when the characteristic pathologic findings are not present.

Chromosomal abnormalities at 14q11, which encodes the T-cell receptor α and δ chain genes, are generally specific for T-cell malignancies, and are rarely reported in other malignancies. We report a novel t(11;14)(p13;q11.2) in a patient with myelofibrosis (MF) following polycythemia vera (PV). This 55-year-old male developed post-PV MF 12 years after the initial diagnosis of PV. He had a normal karyotype at polycythemic disease stage, t(11;14)(p13;q11.2) was newly detected at the time of fibrotic transformation. Therefore, it is likely that this clonal chromosomal abnormality was associated with progression of disease.

RHS는 안면신경 무릎신경절에 수두대상포진바이러스(varicellar zoster virus)가 감염되어 있다가 얼굴과 귀에 분지되어 있는 감각 분지로 재활성화되어 발생한다. 전형적인 3가지 증상인 얼굴마비, 귀 통증, 외이도와 귓바퀴의 소수포성 발진이 나타나면 RHS라고 진단한다. 본 증례는 사람면역결핍바이러스 환자에서 RHS 진단과 치료의 국내 첫 보고이다. 40세 남자가 우측 귀 통증과 귀가 멍멍한 느낌을 주소로 내원하였다. 입원 직후 우측 얼굴의 말초 신경마비, 이루, 두통, 혀의 우측 운동 장애가 나타났으며 우측 외이도와 귓바퀴에 소수포성 발진이 관찰되었다. 입원 10일째 청력저하를 호소하였으며 고막 천공이 관찰되었다. 말초혈액 검사에서 사람면역결핍바이러스(HIV) 항체가 양성으로 도출되었고 확진 검사 양성이 확인되었다. CD4 T cell은 281/μL였다. 치료는 valacyclovir와 steroid를 투여하고 highly active antiretroviral therapy를 시행하였으며 안면마비를 포함한 증상은 치료 후호전되었으나 청력저하는 호전이 없었다.

Infected walled-off pancreatic necrosis (WOPN) is dangerous complication of acute pancreatitis. Open necrosectomy and post-operative irrigation of necrotic cavity have been conventional treatment for infected pancreatic necrosis, however, recently minimally invasive techniques such as endoscopic necrosectomy has been regarded as preferred treatment method for infected WOPN. Endoscopic necrosectomy provides a targeted approach with a reduction in the systemic inflammatory response and avoidance of wound complications. Non alcohol related Wernicke encephalopathy is rare disease caused by thiamine deficiency due to intravenous feeding, and presented an encephalopathy, oculomotor dysfunction, gait ataxia. We report herein a case of Wernicke encephalopathy after successful endoscopic necrosectomy for infected WOPN. Korean J Pancreatobiliary 2016;21(1):34-39

Group B streptococcus (GBS) is a leading cause of life-threatening bacterial infections among newborns, and neonates born to heavily colonized women may be subject to vertical transmission. We sought to determine an appropriate detection method for genital GBS in pregnant women by comparing culture-based methods and real-time polymerase chain reaction (PCR). In addition, we performed molecular serotyping and multilocus sequence typing (MLST) on isolates.A total of 150 pregnant women were enrolled and underwent vaginal-rectal swabbing at 16-40 weeks of gestation. GBS was identified by conventional culture and real-time PCR with or without enrichment. Molecular serotyping and MLST were performed on isolates.Overall genital GBS positive rate among the 150 study subjects was 17.3%. Direct culture identified 18 (12.0%) positive specimens, enrichment culture 22 (14.6%), direct PCR 24 (16.0%) and enrichment PCR 25 (16.6%). The sensitivity and specificity by direct and enrichment PCR were as follows: for direct PCR, 90.9% and 96.9%, respectively; and for enrichment PCR, 95.5% and 96.9%, respectively. Resistance rates to clindamycin and erythromycin were 33.3% and 19.1%, respectively. Serotype III-1 was the most common (26.3%), followed by serotype Ib (21.1%), III-3 (15.8%), V (15.8%), II (10.5%), IV (5.3%) and VI (5.3%). Most common sequence types (ST) were ST-1, ST-19 and ST-862 (15.8%), followed by ST-2 and ST-654 (10.5%).Direct real-time PCR using vaginal-rectal specimen could be used for detecting GBS in emergent conditions. Molecular serotypes III, Ib and V were most common. MLST analysis frequently presented ST-1, ST-19 and ST-862.

Nanomaterials that exhibit enzyme-like characteristics, which are called nanozymes, have recently attracted significant attention due to their potential to overcome the intrinsic limitations of natural enzymes, such as low stability and relatively high cost for preparation and purification. In this study, we report a highly efficient colorimetric allergy detection system based on an immunoassay utilizing the peroxidase-mimicking activity of hierarchically structured platinum nanoparticles (H-Pt NPs). The H-Pt NPs had a diameter of 30 nm, and were synthesized by a seed-mediated growth method, which led to a significant amount of peroxidase-like activity. This activity mainly occurs because of the high catalytic power of the Pt element, and the fact that the H-Pt NPs have a large surface area available for catalytic events. The H-Pt NPs were conjugated to an antibody for the detection of immunoglobulin E (IgE) in the analytes; IgE is a representative marker for the diagnosis of allergies. They were then successfully integrated into a conventionally used allergy diagnostic test, the ImmunoCAP diagnostic test, as a replacement for natural signaling enzymes. Using this strategy, total and specific IgE levels were detected within 5 min at room temperature, with high specificity and sensitivity. The practical utility of the immunoassay was also successfully verified by correctly determining the levels of both total and specific IgE in real human serum samples with high precision and reproducibility. The present H-Pt NP-based immunoassay system would serve as a platform for rapid, robust, and convenient analysis of IgE, and can be extended to the construction of diagnostic systems for a variety of clinically important target molecules.

Objectives: To correlate the microbiological and clinical features of infections caused by Nocardia species. Methods: We determined the species and drug susceptibility of 138 Nocardia strains isolated from 132 patients at the University of Texas M. D. Anderson Cancer Center (Houston, TX) from 2002 through 2012 and analyzed the clinical features. Results: The 132 patients included 82 men and 50 women with a mean age of 59.1 years. All except two had underlying cancer, and 47 (35.6%) also received a stem cell transplant. These patients experienced 136 episodes of Nocardia infection, including pulmonary infection, abscess of deep skin and soft tissue, bacteremia and dissemination, and brain abscess. The 138 Nocardia strains involved 27 species, of which 20 species have been described since 2000. Common species included Nocardia nova, Nocardia cyriacigeorgica, Nocardia farcinica , and Nocardia abscessus , together accounting for 59.4%. N nova caused most bacteremia cases, whereas N farcinica caused most of the skin and brain infections. Infections with a few recent species likely represented first confirmation or report of human infections. Antimicrobial susceptibility tests of 117 strains showed that they were all susceptible to trimethoprim-sulfamethoxazole and linezolid but variably susceptible to other drugs depending on species. Most patients who were treated for the infection showed improvement or resolution. Conclusions: Diverse Nocardia species can cause secondary infections in patients with cancer. Timely species identification and antimicrobial susceptibility tests may guide treatment.

Severe adenovirus pneumonia that causes acute respiratory failure can occur in infants, children, and immunocompromised patients. However, severe adenovirus pneumonia is rare in adults with a normal immune system. Adenovirus pneumonia may progress to acute respiratory failure in a few hours or a few days, and its clinical course cannot be predicted. In addition, the mortality rate is very high (range, 50% to 66%). However, the optimal treatment of adenovirus pneumonia has not been established. Herein, we report the successful treatment of acute respiratory failure due to adenovirus pneumonia with extracorporeal membrane oxygenation.

Diagnostic tests for respiratory viral infections use traditionally either nasopharyngeal washes or swabs. Sputum is representative of the lower respiratory tract but is used rarely for viral testing. The aim of this study was to compare the detection rates of respiratory viruses from nasopharyngeal swabs and sputum using a multiplex real-time reverse transcription-polymerase chain reaction (RT-PCR). Adults who were admitted or presented to the clinics of Gil Medical Center with acute respiratory symptoms were recruited from 1 November 2012 to 31 March 2013. Paired specimens of nasopharyngeal swabs and sputum were obtained from 154 subjects, and RNA was extracted and tested for 16 different respiratory viruses using the Anyplex II RV16 Detection kit (Seegene, Seoul, Korea). The positive rate was 53% (81/154) for nasopharyngeal swabs and 68% (105/154) for sputum (P

Isolated central nervous system (CNS) relapse is a rare, unpredictable event in patients with CML. Some studies have reported cases of isolated CNS relapse in CML [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13]. However, very few studies have reported on isolated CNS relapse in the blast phase (BP) of CML in Korea [14, 15]. We report a case of BP CML with extramedullary lymphoblast proliferation in the CNS without evidence of disease in the peripheral blood (PB) and bone marrow (BM). A 54-yr-old man was diagnosed as having BCR/ABL1 (b2a2 type)-positive CML in July 2012. He was considered to be in the chronic phase on the basis of his blast count on PB smear and BM aspiration, and subsequently, he was administered imatinib (400 mg/day). Three months after diagnosis, he demonstrated a complete hematologic response, major cytogenetic response, and no major molecular response according to the National Comprehensive Cancer Network Guidelines in Oncology for CML (karyotype 46,XY,t(9;22)(q34;q11.2)[7]/46,XY[23], BCR-ABL1 fusion transcript of 0.933% based on the International Scale [IS]) [16]. Seven months after initial diagnosis, he was readmitted with a complaint of headache since two months. Diffusion brain magnetic resonance imaging with magnetic resonance angiography revealed abnormal leptomeningeal enhancement of both paramedian gyri, suggesting involvement of leukemic cells. In cerebrospinal fluid (CSF) study, his CSF was turbid and had increased number of white blood cells (WBCs) (3.5×109/L), and almost all WBCs were lymphoid cells. Wright stain of cytospin-smeared CSF showed lymphoid cells with high nuclear-to-cytoplasmic ratio and coarse chromatin pattern with prominent nucleoli. Lymphoid cells were negative on periodic acid-Schiff staining. In flow cytometric analysis, the lymphoid cells had an early pre-B phenotype with an aberrant CD33 expression (positive for CD45, CD34, CD33, terminal deoxynucleotidyl transferase (TDT), HLA-DR, CD19, and CD10). The result of reverse transcriptase-PCR for detecting BCR-ABL1 fusion transcript was positive (b2a2 type) in CSF. On complete blood count analysis, Hb level was 13.3 g/dL, WBC count was 11.41×109/L, and platelet count was 167×109/L. There was no morphologic evidence of lymphoblasts in PB and BM samples (Fig. 1). The patient was treated with dasatinib, intrathecal methotrexate, and cranial irradiation therapy. One week after initiation of treatment, CSF showed decreased WBCs (0.002×109/L) with no evident malignant cells. Two months after relapse, patient demonstrated a complete hematologic response, complete cytogenetic response, and major molecular response (karyotype 46,XY[30], BCR-ABL1 fusion transcript of 0.011% by IS). His laboratory findings are summarized in Table 1. Fig. 1 Cerebrospinal fluid (CSF) findings at seven months after initial diagnosis of CML. (A) Cytospin-smeared CSF showing numerous lymphoid cells with high nuclear-to-cytoplasmic ratio and coarse chromatin pattern with prominent nucleoli (Wright stain, ×1,000). ... Table 1 Brief laboratory data of the case This patient showed optimal response to imatinib therapy that was administered according to the European Leukemia Net recommendation [17]. However, spontaneous, isolated CNS relapse occurred after 7 months of imatinib therapy. In previous reports, isolated CNS relapse was observed in patients with imatinib-treated CML or Philadelphia chromosome-positive acute lymphoblastic leukemia [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. This phenomena raised the possibility that imatinib may poorly penetrate the blood-brain barrier. Some studies have demonstrated that imatinib does not reach therapeutic levels in CSF, and therefore, imatinib therapy alone may lead to a potential risk of CNS involvement [1, 10]. We present a summary of 15 cases of isolated CNS relapse in CML patients in Table 2. Isolated CNS relapse was predominantly observed in men (M:F=11:4) with a median age of 42 yr (range, 17-73 yr). The major presenting symptom of isolated CNS relapses was headache with or without other neurologic symptoms. Nine of 15 cases (60%) had complete cytogenetic response state at CNS relapse. The median time from treatment initiation to CNS relapse was 25 months (range, 4-58 months) in 15 cases. Findings from these cases show that isolated CNS relapse has no correlation with a response to imatinib therapy. No other sites were involved, except for CNS in all of the 15 cases, and eight cases had B-cell lymphoid phenotype of blasts [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. In our case, the patient was a middle-aged man experiencing headaches as the initial manifestation of CNS relapse. Excluding the case in a 17-yr-old patient [6], the time interval from the diagnosis to CNS relapse in our case was shorter (7 months) than the previously reported cases. Most of the previous cases had received additional treatment with intrathecal chemotherapy and cranial irradiation, and had showed good response [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. Nishimoto et al. [13] reported a case with successful treatment with dasatinib and allogeneic hematopoietic stem cell transplantation (HSCT). Our patient was also treated with dasatinib after CNS relapse in BP of CML, and is currently being prepared to receive HSCT. Brain imaging, CSF study, or CNS prophylaxis are not routinely undertaken in patients with chronic phase CML at diagnosis. To our knowledge, there are no recommendations on the evaluation of CNS disease in CML patients. There are prognostic classifications using four factors, such as age, size of spleen, platelet count, and blast count at diagnosis and they remain valid for imatinib treatment [18, 19, 20]. Our patient was at high risk according to risk stratifications by Hasford et al. [19] and Sokal et al. [20] (Hasford score 1,509 and Sokal score 1.35). However, risk factors of CNS relapse have not been investigated. Further studies are needed to identify risk factors of CNS relapse. Table 2 Cases of isolated CNS blast crisis in CML To our knowledge, this is the third report of isolated CNS lymphoblast proliferation in a Korean CML patient. It is important to consider CNS relapse in chronic phase CML patients optimally treated with imatinib, especially in patients presenting with neurological symptoms, including headache. This emphasizes the need for brain imaging study and CSF monitoring in imatinib-treated CML patients even without evidence of disease progression on PB smear and BM studies.

Purpose Inadequate empirical therapy for severe infections caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBLEC) is associated with poor outcomes. This study was designed to investigate risk factors for community-onset ESBLEC bacteremia at admission to a tertiary care hospital. Materials and Methods A case-control study was performed that included all episodes of ESBLEC bacteremia in the outpatient department or within 48 hours of admission from January 2005 to March 2009. Data on predisposing factors were collected. The molecular epidemiology of ESBLEC clinical isolates was also determined. Results Among 25281 blood cultures, 60 episodes of ESBLEC bacteremia were studied, which accounted for 7% of all E. coli bacteremia at admission. Healthcare-associated infection [odds ratio (OR), 8.3; 95% confidence interval (CI), 2.4-28.7; p=0.001], malignancy (OR, 4.6; 95% CI, 1.3-16.3; p=0.018), urinary tract infection (OR, 139.1; 95% CI, 24.6-788.2; p

Background Bone marrow (BM) study plays an important role as initial investigation specimen of lymphoma as well as staging lymphoma. This study aimed to investigate the utility of BM studies for classification of lymphoma and evaluate features of BM involvement by lymphoma over a period of 11 years. Methods A total of 1162 cases of BM studies for lymphoma evaluation were reviewed for the incidence of lymphoma subtypes, the percentage of marrow involvement, the pattern of involvement and discordance with histopathologic diagnoses of lymph nodes and other tissues. Results A total of 255 of 1162 cases underwent BM study without pathologic information, and 108 cases show lymphoma involvement. Lymph node biopsy underwent in 66 cases, and 10 cases show discordant result between BM and lymph node biopsy. Seven discordant cases were due to insufficient further studies. Lymphoma was diagnosed only by BM study in 38 cases. Abnormal lymphocytes were found in BM aspiration in 34 cases. Also, abnormal clonal lymphocytes were detected by flow cytometry in 26 cases. Four cases showed disease-related chromosomal abnormalities. FISH analysis detected abnormal findings in two cases, however, discordant with other additional studies. Conclusions Discrepancies between the BM study and lymph node biopsy were due to insufficient further study and discordance of immunohistochemical stain result. BM study can be utilized as initial diagnosis of lymphoma by the combination of morphological feature, involvement pattern, and additional tests such as flow cytometry, chromosomal analysis, and FISH analysis. Thus, BM study with further analysis is an essential choice when lymph node biopsies are unavailable.

Mucormycosis is an opportunistic infection caused by fungi of the order Mucorales, environmental nonseptate molds widely distributed in soil, plants, and decaying materials [1]. Mucormycosis can be divided into the following categories on the basis of the site of infection: rhinocerebral, pulmonary, cutaneous, and disseminated [2-4]. The most common clinical presentation is rhinocerebral disease, followed by pulmonary infection.

Background N-ras mutations are one of the most commonly detected abnormalities of myeloid origin. N-ras mutations result in a constitutively active N-ras protein that induces uncontrolled cell proliferation and inhibits apoptosis. We analyzed N-ras mutations in adult patients with AML at a particular institution and compared pyrosequencing analysis with a direct sequencing method for the detection of N-ras mutations. Methods We analyzed 90 bone marrow samples from 83 AML patients. We detected N-ras mutations in codons 12, 13, and 61 using the pyrosequencing method and subsequently confirmed all data by direct sequencing. Using these methods, we screened the N-ras mutation quantitatively and determined the incidence and characteristic of N-ras mutation. Results The incidence of N-ras mutation was 7.2% in adult AML patients. The patients with N-ras mutations showed significant higher hemoglobin levels (P=0.022) and an increased incidence of FLT3 mutations (P=0.003). We observed 3 cases with N-ras mutations in codon 12 (3.6%), 2 cases in codon 13 (2.4%), and 1 case in codon 61 (1.2%). All the mutations disappeared during chemotherapy. Conclusions There is a low incidence (7.2%) of N-ras mutations in AML patients compared with other populations. Similar data is obtained by both pyrosequencing and direct sequencing. This study showed the correlation between the N-ras mutation and the therapeutic response. However, pyrosequencing provides quantitative data and is useful for monitoring therapeutic responses.

Introduction The Mindray CAL 8000 is a cellular analysis line that consists of the BC-6800, an automated hematology analyzer, and the SC-120, an automated slidemaker/stainer. We evaluated the performances of the BC-6800 and the SC-120. Methods Four hundred and eight normal and abnormal samples were analyzed. The performance of the BC-6800 and Sysmex XE-2100 were compared, and blood films by the SC-120 and manual method were compared according to the CLSI guideline H26-A2 and H20-A2. Results Most parameters measured by the BC-6800 matched well with the XE-2100 and manual differential. The flag efficiency of the BC-6800 for blasts (95.3%) and atypical lymphocytes (92.6%) were higher while immature granulocytes (89.7%) and NRBCs (94.1%) were lower than that of the XE-2100. Additionally, the BC-6800 detected four of five samples infected with plasmodium parasites. The SC-120 showed no carry-over and expected repeatability. There was good agreement on the five-part differential including abnormal cells between blood films by the SC-120 and manually prepared blood films. The shape of the RBC was also comparable between blood films. Conclusion The CAL-8000 analysis line is beneficial for precise, fast hematology work, and even more useful in malaria endemic areas.

Changes of platelet count (PLT) and platelet parameters have been reported in iron deficiency anemia (IDA). However, the relationship between iron metabolism and thrombopoiesis is not yet fully known. We studied the relationship between iron and platelet parameters in women with IDA and thrombocytosis. Forty-one adult women with IDA and thrombocytosis were enrolled. The relationship between iron parameters (such as serum iron, serum ferritin, total iron-binding capacity (TIBC)C, and transferrin saturation (Tfsat)), and platelet parameters (PLT, platelet crit (PCT), mean platelet volume (MPV), mean platelet component (MPC), mean platelet mass, platelet distribution width, and large platelet (LPLT)), which measured with CBC on ADVIA, were investigated. In addition, the difference in platelet and iron parameters between severe IDA (Hb 7 g/dl) and non-severe IDA were compared. PLT inversely correlated with serum iron and Tfsat (p 0.05). Serum iron and TIBC revealed no significant relationships with any platelet parameters. PLT, PCT, and MPV inversely correlated with mean corpuscular hemoglobin concentration (MCHC) but MPC exhibited linear correlation with Hb, hematocrit, and MCHC (p 0.05). PCT had linear correlation with PLT and MPV (p 0.001), whereas PCT, MPV, and LPLT (p 0.001 for two formers, p 0.05) inversely correlated with MPC. In this study, the important iron parameters affecting PLT were serum iron and Tfsat. In addition, patients with more severe and hypochromic anemia had higher PLT, PCT, and MPV.

B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma (BL) (intermediate DLBCL/BL), is a heterogeneous group with some features resembling DLBCL and others resembling BL. Here, we report a case of intermediate DLBCL/BL in a Korean child. A 2-yr-old male was admitted for evaluation and management of left hip pain. Immunohistochemistry of a biopsy of the femur neck revealed tumor cells positive for CD20, CD10, BCL2, BCL6, and Ki67. A bone marrow (BM) aspirate smear revealed that 49.3% of all nucleated cells were abnormal lymphoid cells, composed of large- and medium-sized cells. Immunophenotyping of the neoplastic cells revealed positivity for CD19, CD10, CD20, and sIg lambda and negativity for CD34, Tdt, and myeloperoxidase (MPO). Cytogenetic and FISH analyses showed a complex karyotype, including t(8;14)(q24.1;q32) and IGH-MYC fusion. Intensive chemotherapy was initiated, including prednisone, vincristine, L-asparaginase, daunorubicin, and central nervous system prophylaxis with intrathecal methotrexate (MTX) and cytarabine. One month after the initial diagnosis, BM examination revealed the persistent of abnormal lymphoid cells; cerebrospinal fluid cytology, including cytospin, showed atypical lymphoid cells. The patient was treated again with cyclophosphamide, vincristine, prednisone, adriamycin, MTX, and intrathecal MTX and cytarabine. The patient died of sepsis 5 months after the second round of chemotherapy.

Background : For the diagnosis of essential thrombocythemia (ET), no single clinical or laboratory finding of diagnostic value is available and a differential diagnosis of other myeloproliferative neoplasms or reactive thrombocytosis (RT) is needed. Following recent developments in automated blood cell analyzers, various platelet indices can now be measured. In this study, we analyzed whether platelet counts and 6 platelet indices can be used for the differentiation of ET from RT in patients with a platelet count of 600 ×10 3 /mL or more. Methods : The subjects studied were 31 patients with ET and 224 patients with RT. The platelet counts, mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW), mean platelet mass (MPM), mean platelet component concentration (MPC) and large platelets (LPLT) were measured by ADVIA 120 (Bayer Diagnostics, USA). The mean values of each item were compared between the two patient groups and the sensitivity and specificity of each item in the diagnosis of ET were determined by ROC curve analysis. Results : In essential thrombocythemia, all parameters except MPC were significantly higher than in reactive thrombocytosis. For the diagnosis of ET, the sensitivity and specificity were: 74.2% and 84.4%, when the platelet count was ≥820×10 3 /mL; 80.6% and 80.0%, when the plateletcrit was ≥ 0.63%; and 64.5% and 99.1%, respectively, when LPLT was ≥23×10 3 /mL. Conclusions : The platelet counts and platelet indices are useful for the differential diagnosis of thrombocytosis. The plateletcrit and LPLT are particularly useful for the diagnosis of ET when the platelet count is markedly increased. (Korean J Lab Med 2009;29:505-9)

Background Mutations in calreticulin (CALR) have been reported to be key markers in the molecular diagnosis of myeloid proliferative neoplasms. In most previous reports, CALR mutations were analyzed by using Sanger sequencing. Here, we report a new, rapid, and convenient system for screening CALR mutations without sequencing. Methods Eighty-three bone marrow samples were obtained from 81 patients with thrombocytosis. PCR primers were designed to detect wild-type CALR (product: 357 bp) and CALR with type 1 (product: 302 bp) and type 2 mutations (product: 272 bp) in one reaction. The results were confirmed by Sanger sequencing and compared with results from fragment analysis. Results The minimum detection limit of the screening PCR was 10 ng for type 1, 1 ng for type 2, and 0.1 ng for cases with both mutations. CALR type 1 and type 2 mutants were detected with screening PCR with a maximal analytical sensitivity of 3.2% and

AimsPrevious studies have suggested many prognostic factors in diffuse large B-cell lymphoma (DLBCL), but the prognostic importance of cell-of-origin and discordant bone marrow involvement remains unclear. The aim of this study was to evaluate the prognostic impact of bone marrow involvement histological subtype, cell-of-origin subtype and international prognostic index (IPI) scores in patients with DLBCL.MethodsPatients who were newly diagnosed with DLBCL and treated with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) were analysed. Clinical information was reviewed retrospectively. Patients were classified into negative, concordant and discordant bone marrow involvement by histological review. The cell-of-origin types were defined using immunohistochemical analysis.ResultsBoth concordant and discordant bone marrow involvement had a negative prognostic impact on progression-free survival, independent of the standard and National Comprehensive Cancer Network (NCCN) IPI scores and cell-of-origin. Patients with non-germinal centre B-cell type showed significantly shorter progression-free survival than those with germinal centre B-cell type. However, non-germinal centre B-cell type did not have a prognostic impact on progression-free survival or overall survival after controlling for the standard and NCCN-IPI and bone marrow involvement.ConclusionsBoth concordant and discordant bone marrow involvement had an adverse prognostic impact on progression-free survival and overall survival; this was independent of the standard and NCCN-IPI and cell-of-origin (non-germinal centre B-cell type). The NCCN-IPI had more powerful prognostic value than the standard IPI (sIPI). The non-germinal centre B-cell type lost significant prognostic impact on progression-free survival after adjustment for standard and NCCN-IPI and bone marrow involvement.

Complex variant 15;17 translocations are increasingly recognized in acute promyelocytic leukemia (APL). We report the case of a 47-year-old woman with APL harboring a novel four-way translocation. She presented with persistent bleeding after a tooth extraction. Blood cell counts at admission were hemoglobin at 9.0 g/dL, platelets at 15 x 10(9)/L, and white blood cells at 0.460 x 10(9)/L with abnormal promyelocytes. Most nucleated cells of bone marrow aspirates were abnormal promyelocytes with Auer rods. Chromosome analysis of unstimulated bone marrow cell cultures revealed a variant t(15;17) in the form of t(10;17;15;22)(q22;q21;q22;q11.2). Fluorescence in situ hybridization with a PML/RARA dual-color DNA probe showed the fusion signals on der(15) and the residual PML signals on der(22). RT-PCR showed long-form PML/RARA fusion transcripts. A complete remission was attained with a course of conventional chemotherapy including ATRA. A literature review revealed that our case is one of the very rare four-way translocations and the first report of the involvement of chromosomes 10 and 22 in a variant t(15;17).

OBJECTIVES We compared vascular and metabolic responses (and adverse responses) to statin and fibrate therapies alone or in combination in patients with combined hyperlipidemia. BACKGROUND The mechanisms of action for statins and fibrates are distinct. METHODS Fifty-six patients were given atorvastatin 10 mg and placebo, atorvastatin 10 mg and fenofibrate 200 mg, or fenofibrate 200 mg and placebo daily during each two-month treatment period of a randomized, double-blind, placebo-controlled crossover trial with two washout periods of two months' each. RESULTS Lipoproteins were changed to a greater extent with combined therapy when compared with atorvastatin or fenofibrate alone. Flow-mediated dilator response to hyperemia and plasma high-sensitivity C-reactive protein and fibrinogen levels were changed to a greater extent with combined therapy when compared with atorvastatin or fenofibrate alone (p < 0.001, p = 0.182, and p = 0.015 by analysis of variance [ANOVA], respectively). The effects of combined therapy or fenofibrate alone on plasma adiponectin levels and insulin sensitivity (determined by the Quantitative Insulin-Sensitivity Check Index [QUICKI]) were significantly greater than those of atorvastatin alone (p = 0.022 for adiponectin and p = 0.049 for QUICKI by ANOVA). No patients were withdrawn from the study as the result of serious adverse effects. CONCLUSIONS Combination therapy is safe and has beneficial additive effects on endothelial function in patients with combined hyperlipidemia.

Analysis of thrombopoiesis is important in evaluating hemato-logic and non-hematologic diseases. Recent improvements in automated blood 4cell analyzers allow measurement of several platelet parameters, providing additional information on the un-derlying mechanisms of thrombocytosis and thrombocytopenia. The ADVIA

Angiotensin II stimulates the expression of tissue factor (TF) and plasminogen activator inhibitor type-1 (PAI-1), and AT1 receptor blockade (ARB) reduces PAI-1 and TF activities in experimental studies. We investigated the effects of ARBs on TF activity, tissue plasminogen activator (tPA), PAI-1 antigen levels, plasma renin activity (PRA) and aldosterone levels in hypertensive patients. Placebo, losartan 100mg, irbesartan 300 mg, and candesartan 16 mg daily were administered to 122 patients for 2 months. Compared with placebo, ARBs significantly reduced TF activity (P

Mechanisms underlying biological effects of statin and angiotensin-converting enzyme inhibitor therapies differ. Thus, we studied vascular responses to combination therapy in hypercholesterolemic patients. A randomized, double-blind, placebo-controlled, crossover trial was conducted with 50 hypercholesterolemic patients with simvastatin and either placebo or ramipril (study I) and in 45 hypercholesterolemic diabetic patients with simvastatin or ramipril with placebo or simvastatin combined with ramipril (study II) for 2 months with 2 months washout. In study I simvastatin combined with ramipril significantly reduced blood pressure after 2 months. Simvastatin alone or combined with ramipril significantly changed lipoproteins, improved percent flow-mediated dilator response to hyperemia by 30±5% and 53±6%, respectively ( P P =0.026) and 25±4% ( P P =0.049 and P =0.001, respectively), C-reactive protein levels changed by 0% and 18%, respectively ( P =0.036 and P P =0.828 and P P P =0.048 by ANOVA, respectively). Ramipril alone or simvastatin combined with ramipril significantly improved the percent flow-mediated dilator response to hyperemia (both P P

Dear Editor, Bone marrow (BM) oxalosis is a type of systemic oxalosis wherein oxalate is deposited in BM. It is characterized by cytopenias, leukoerythroblastosis, and hepatosplenomegaly [1] as well as BM findings of calcium oxalate crystals that are birefringent under polarized microscopy and granulomatous structures [2]. Hyperoxaluria (excessive urinary excretion of oxalate) can develop into systemic oxalosis when oxalate is deposited in organs [3]. Hyperoxaluria is classified as primary or secondary. Primary hyperoxaluria is an autosomal recessive disease with defective oxalate metabolism [3] in which the overproduction of oxalate results from an enzyme deficiency in the liver; its clinical presentation involves nephrocalcinosis and renal impairment. Systemic deposition of excess oxalate occurs in the bone and all organs and tissues, except the liver. The retina, arteries, peripheral nervous system, myocardium, thyroid, skin, and BM are the major areas of oxalate deposition. Bone is the most common site, although the bone lesions can mimic clinical renal osteo-dystrophy [4,5]. Primary hyperoxaluria includes three types of enzyme deficiency. The most common form is primary hyperoxaluria type I, with an incidence rate of approximately 1/120,000 live births per year in Europe. It is caused by a mutation in the AGXT gene resulting in a functional defect of the liver enzyme alanine-glyoxylate aminotransferase and represents 80% of primary hyperoxaluria. Primary hyperoxaluria type II is caused by a deficiency of glyoxylate reductase/hydroxypyruvate reductase (GRHPR), and type III is caused by a deficiency of the mitochondrial enzyme HOGA1 [2,3]. Secondary hyperoxaluria occurs when dietary and intestinal absorption of oxalate or intake of oxalate precursors is increased and the intestinal microflora is changed [3]. The clinical presentation of secondary hyperoxaluria is similar to that of primary hyperoxaluria, although systemic oxalosis is less common [3]. We present a case of BM oxalosis with pancytopenia in a patient who had been on hemodialysis after bilateral nephrectomy due to recurrent nephrocalcinosis. A 51-yr-old male patient underwent a BM biopsy due to pancytopenia. He had been on hemodialysis via an arterio-venous graft since 2009 when he underwent a bilateral nephrectomy owing to recurrent renal stones and renal failure. One of his siblings had died owing to end-stage renal disease in his or her 30s (the sex is unknown). The patient had no history of a high-oxalate diet or gastrointestinal symptoms. His complete blood count revealed a Hb level of 5.7 g/dL, white blood cell count of 1.2×109/L (absolute neutrophil count 0.81), and platelet count of 98×109/L. Anemia persisted for five years despite treatment with erythropoietin, and leukopenia and thrombocytopenia also developed. Radiography revealed diffuse sclerotic changes and osteolytic lesions in multiple sites that resulted in a spontaneous fracture in his elbow. Endocrinologically, subclinical hypothyroidism was present with an increased thyroid-stimulating hormone level of 5.344 mIU/L (reference range 0.55-4.78 mIU/L), and a near-normal free thyroxine level of 8.1 ng/L (reference range 8.9-17.8 ng/L). Laboratory data showed the following: blood urea nitrogen, 0.36 g/L, creatinine, 43 mg/L, and erythropoietin 33.2 IU/L (reference rage 4.3-29 IU/L). Tear drop cells and left-shifted neutrophils were observed on a peripheral blood smear. BM aspirates were hemodiluted and showed a few multinucleated giant cells. Extensive oxalate crystals depositions surrounded by macrophages and granulomatous formations were revealed on BM biopsy. The crystals were birefringent under polarized microscopy (Fig. 1). The patient demonstrated systemic oxalosis involving the bone, possibly thyroid, and BM, with no evidence of involvement in the retina, arteries, peripheral nervous system, myocardium, or skin. Fig. 1 (A) Pancytopenia showing tear drop cells indicated by the arrow (peripheral blood smear, Wright stain, ×1,000). (B) Bone marrow biopsy shows oxalate crystals surrounded by granuloma (Hematoxylin & Eosin stain, ×200). (C) Crystals ... The familial history of a sibling who had died of end-stage renal disease and the presentation of systemic oxalosis involving bone, thyroid, and BM, and no evidence of a secondary cause, such as diet, suggested a diagnosis of primary hyperoxaluria. However, genetic testing could not be performed because the patient was transferred to a secondary hospital and lost to follow-up. BM oxalosis is a rare disease presenting with cytopenia, especially treatment-resistant anemia and renal failure [2]. The development of pancytopenia is a rare and late finding [2,6]. BM aspirate is often hemodiluted owing to crystals. Calcium oxalate crystalline deposits surrounded by granulomatous structures are observed on BM biopsy [2]. Early diagnosis and appropriate conservative treatment is required to prevent the possible complications resulting from cytopenias. Kidney or combined liver and kidney transplantation is the treatment of choice for systemic oxalosis [7]. This is the first case report of BM oxalosis in Korea. BM oxalosis should be considered as a possible diagnosis in patients in renal failure with pancytopenia or treatment-resistant anemia.

Identification of rapidly growing mycobacteria (RGM) is problematic because there are many taxonomic changes. 16S rRNA gene is commonly used to identify Mycobacterium species, but alternative gene targets have been introduced for more accurate identification. We report a rare case of a prosthetic knee infection due to Mycobacterium wolinskyi. The isolate was not identified by 16S rRNA gene sequencing alone and substantially confirmed by rpoB gene sequencing. The identification was delayed because our laboratory did not routinely identify RGM to the species level. Simultaneous sequencing of both 16S rRNA and rpoB genes will allow rapid and accurate identification of M. wolinskyi isolates.

Purpose. To report a case of corneal co-infection of Stenotrophomonas maltophilia and Aspergillus fumigatus. Methods. We describe a culture and biopsy proven infectious keratitis with a large, brown, round anterior chamber mass attached to the endothelium. Results. Stenotrophomonas maltophilia was cultured from external scrapings of a corneal ulcer and septate hyphae were stained with Gomori's methenamine silver(GMS) stain along the wall of the excised intracameral mass. Aspergillus fumigatus was cultured from the mass and pus pockets developed along the corneoscleral incision for removal of the mass. Conclusion. Co-infection of cornea with Stenotrophomonas maltophilia and Aspergillus fumigatus with existence of a large, brown, smooth-surfaced mass in the anterior chamber makes this case unique and interesting.

Background Clostridium difficile is a major pathogen responsible for nosocomial infectious diarrhea. We explored optimal laboratory strategies for diagnosis of C. difficile infection (CDI) in our clinical settings, a 1400-bed tertiary care hospital. Methods Using 191 fresh stool samples from adult patients, we evaluated the performance of Xpert C. difficile (Xpert CD), C. diff Quik Chek Complete (which simultaneously detects glutamate dehydrogenase [GDH] and C. difficile toxins [CDT]), toxigenic culture, and a two-step algorithm composed of GDH/CDT as a screening test and Xpert CD as a confirmatory test. Results Clostridium difficile was detected in 35 samples (18.3%), and all isolates were toxigenic strains. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of each assay for detecting CDI were as follows: Quik Chek Complete CDT (45.7%, 100%, 100%, 89.1%), Quik Chek Complete GDH (97.1%, 99.4%, 97.1%, 99.4%), Xpert CD (94.3%, 100%, 100%, 98.7%), and toxigenic culture (91.4%, 100%, 100%, 98.1%). A two-step algorithm performed identically with Xpert CD assay. Conclusion Our data showed that most C. difficile isolates from adult patients were toxigenic. We demonstrated that a two-step algorithm based on GDH/CDT assay followed by Xpert CD assay as a confirmatory test was rapid, reliable, and cost effective for diagnosis of CDI in an adult patient setting with high prevalence of toxigenic C. difficile.

목적: 침습 B군 사슬알균(group B streptococcus [GBS]) 감염증에서 분리된 균의 혈청형과 임상적 특징의 관계를 분석하고자 하였다. 방법: 가천대 길병원과 삼성서울병원에 입원한 GBS 감염 환자 데이터를 후향적으로 수집하고 슬라이드 응집법으로 혈청형을 정하였다. 결과: 총 37명 중 만삭아 22명, 미숙아 15명이었고, 조발형 15명(40.5%), 지발형 19명(51.4%), 늦은 지발형 3명(8.1%)이었다. 조발형이 미숙아에서 더 많이 발생하였다(P =0.17). 임상 양상은 균혈증(70.3%)이 가장 흔했고, 수막염, 화농관절염 순이었다. 혈청형 분석이 가능했던 24 균주 중 III형이 가장 흔했고 (41.7%), V (16.7%), Ia, Ib, II (각각 12.5%), non-typeable (4.2%)였다. III형은 만삭아에서 더 많았던 반면, V형은 미숙아에서 더 흔했다. 페니실린 내성균은 없었고 에리트로마이신과 클린다마이신 내성은 각각 64.9%였다. 결론: GBS는 미숙아와 만삭아에게 모두 중요한 병원체이며 혈청형 분포에서도 미숙아와 만삭아 간에 차이가 있을 수 있다. 조발형 질환의 발생을 과소평가하지 않고 적절한 예방 대책을 마련하기 위해 미숙아를 포함한 GBS 질환의 전국적인 역학을 감시하는 것이 필요하다.

Although patients with Plasmodium vivax malaria usually recover from the disease without any sequelae, several complications do occasionally occur and these may need urgent invasive procedures, including surgery, and/or lead to fatal blood loss (Jacobs et al., 2005; Gockel et al., 2006; Maguire and Baird, 2010). Worryingly, the incidence of complications in P. vivax malaria, such as acute respiratory-distress syndrome or splenic rupture, appears to be increasing (Kasliwal et al., 2009). A case of P. vivax malaria complicated by spontaneous haemothorax (perhaps the first ever reported) is described below.

To correlate the microbiological and clinical features of infections caused by Nocardia species.We determined the species and drug susceptibility of 138 Nocardia strains isolated from 132 patients at the University of Texas M. D. Anderson Cancer Center (Houston, TX) from 2002 through 2012 and analyzed the clinical features.The 132 patients included 82 men and 50 women with a mean age of 59.1 years. All except two had underlying cancer, and 47 (35.6%) also received a stem cell transplant. These patients experienced 136 episodes of Nocardia infection, including pulmonary infection, abscess of deep skin and soft tissue, bacteremia and dissemination, and brain abscess. The 138 Nocardia strains involved 27 species, of which 20 species have been described since 2000. Common species included Nocardia nova, Nocardia cyriacigeorgica, Nocardia farcinica, and Nocardia abscessus, together accounting for 59.4%. N nova caused most bacteremia cases, whereas N farcinica caused most of the skin and brain infections. Infections with a few recent species likely represented first confirmation or report of human infections. Antimicrobial susceptibility tests of 117 strains showed that they were all susceptible to trimethoprim-sulfamethoxazole and linezolid but variably susceptible to other drugs depending on species. Most patients who were treated for the infection showed improvement or resolution.Diverse Nocardia species can cause secondary infections in patients with cancer. Timely species identification and antimicrobial susceptibility tests may guide treatment.

Thrombocytopenia is caused by insufficient production and excessive destruction of platelets. Recent improvement of automated blood cell analyzers has allowed measurement of several platelet parameters, providing better understanding of the underlying mechanisms of thrombocytopenia. We investigated the significance of platelet parameters in thrombocytopenic patients. Thrombocytopenic patients (platelet

Background The validity of self-reported varicella history and cost-effectiveness of a prevaccination screening strategy have not been examined among health care workers (HCWs) living in Korea. Methods We investigated varicella-zoster virus immunity of all HCWs in high-risk departments. To determine the history of varicella, all applicants completed a standardized questionnaire at the time of blood sampling for serologic testing. Results Of the 550 HCWs, 526 (96%) were varicella seropositive. Although self-reported history was highly predictive of seropositivity (≥96%) among all age groups, the negative predictive value was extremely low (4%-5%) among all age groups. The prevaccination screening strategy was cheaper than vaccination without antibody screening if the varicella seroprevalence was >28%. Conclusion Seroprevalence was high (≥95%) among HCWs born in Korea before 1988. The self-reported varicella history did not accurately predict immunity, especially for individuals who have negative or uncertain varicella history. Given the high seroprevalence of varicella in Korean HCWs, serologic screening before vaccination was more cost-effective than universal vaccination.

eISSN 2093-6338 생이 감소하고 생존율이 향상될 수 있으며, 성인을 대상으로 한 최 근의 국내외 연구들은 1:1:1 비율의 공급을 권고하고 있다[3, 4]. 더 욱이 대량수혈을 필요로 하는 경우, 환자의 평가부터 대량수혈을 마칠 때까지의 일련의 과정을 프로토콜화 함으로써 응급 상황에 서 임상의사는 환자의 상태에 더 집중할 수 있고 혈액은행은 더욱 빠르고 실수 없이 혈액제제를 준비할 수 있다. 무엇보다 이러한 프 로토콜은 환자의 생존율을 높이고 사용되는 혈액제제의 양도 줄 일 수 있다는 장점이 있다[5]. 그러나 이러한 프로토콜 대부분은 성인을 대상으로 연구되고 시행되고 있으며, 소아 환자를 대상으로 하는 연구는 아직 미흡한 수준이다. 비록 소아의 경우 대량수혈을 필요로 하는 경우가 성인 에 비해 적고 생리적 저장량이 많아 출혈에 더 잘 견딜 수 있으나, 손상기전이 성인과 다르고 나이에 따라 다양한 체내 혈액량을 갖 는다. 더욱이 소아 외상 환자의 경우 성인에 비해 응고병증이 더 흔 하게 발생하며, 이러한 응고병증은 높은 사망률로 이어지게 되므 로 소아 환자의 대량수혈에 대해 좀 더 광범위한 연구가 필요한 실 정이다[6]. 현재 본원 외상센터에서는 성인 대량출혈 환자 발생 시, 산소 공 급 및 ABO type, Ab screening test, ABGA, CBC, PT/aPTT, fibrin최근 각종 장기의 이식수술을 포함한 복잡한 수술의 증가, 체외 막산소화 장치 사용의 증가, 그리고 외상센터의 증가 등에 의해 대 량수혈이 필요한 경우가 많아지고 있다[1]. 2014년 국내에서 발간된 수혈가이드라인(제2차 개정판)에서는 대량수혈을 24시간 이내에 환자의 전체 체내혈액량 이상을 수혈하는 것으로 정의하고 있으 며, 대량수혈은 산소운반능을 유지하는 것보다는 유효순환 혈액 량을 유지하는 것이 목표이므로 신선동결혈장과 함께 혈소판제제, 결정질액 또는 교질액을 같이 사용하게 된다[2]. 적혈구제제, 신선 동결혈장, 그리고 혈소판제제 등이 균형을 이룰 때 응고병증의 발 소아 환자에서의 대량수혈 프로토콜 Massive Transfusion Protocols for Pediatric Patients

TO THE EDITOR: Acute myeloid leukemia (AML) with t(4;12) is rare, but its unique morphologic and clinical characteristics have been described in several reports [1,2,3,4,5,6,7,8]. Most cases show CD7 expression, low or absent myeloperoxidase activity, basophilia, unique blast morphology, dysplastic features, and poor prognosis [1,2,3,4,5,6,7,8]. Harada et al. reported that the incidence among adults is 0.6% [1,2]. ETV6, at 12p13, and CHIC2, at 4q12, have been reported to be involved in AML [5,8]. Here, we report 2 cases of AML with t(4;12) (q12;p13) which showed the common characteristics of AML with t(4;12).