Effect of Focal Laser Photocoagulation on the Ganglion Cell Complex Thickness in Acute Central Serous Chorioretinopathy

This study investigated the changes in the ganglion cell complex (GCC) of patients with acute central serous chorioretinopathy (CSC) following focal laser photocoagulation (FLP) and sought to determine its correlation with visual acuity (VA). Our retrospective study was conducted on 30 patients diagnosed with acute CSC between January 2015 and April 2022, who underwent FLP within 3 months of symptom onset. The study assessed GCC changes by measuring the thickness of its inner retinal layers-retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) using optical coherence tomography (OCT). GCC thickness was compared between the affected and unaffected eyes and a healthy control group. VA was also assessed at baseline and at 1, 3, and 6 months post-treatment. VA showed significant improvement from 0.20 ± 0.14 at baseline to 0.10 ± 0.12 logMAR at 6 months post-treatment (p = 0.003). There was no significant change in GCC thickness over the 6-month period. No significant differences in GCC thickness were observed when comparing CSC eyes with fellow eyes or with normal controls at any time point. Final VA was significantly related only to baseline VA, with no correlation found with other factors, including RNFL, GCL, and IPL thickness. In summary, for patients with acute CSC undergoing FLP, our findings indicate that there is no significant change in GCC thickness detectable by OCT before and after the resolution of subretinal fluid (SRF), despite improvements in VA post-laser treatment. This suggests that any potential impact of FLP on GCC thickness may be minimal and not discernible with the current measurement methods, such as OCT, emphasizing that VA improvements may be primarily associated with alterations in the outer retina rather than the inner retina. Further studies with extended follow-up durations are warranted to evaluate any potential long-term changes in GCC.

Multi-MicroRNA Analysis Can Improve the Diagnostic Performance of Mammography in Determining Breast Cancer Risk

The objective of this study was to determine whether multi-microRNA analysis using a combination of four microRNA biomarkers (miR-1246, 202, 21, and 219B) could improve the diagnostic performance of mammography in determining breast cancer risk by age group (under 50 vs. over 50) and distinguish breast cancer from benign breast diseases and other cancers (thyroid, colon, stomach, lung, liver, and cervix cancers). To verify breast cancer classification performance of the four miRNA biomarkers and whether the model providing breast cancer risk score could distinguish between benign breast disease and other cancers, the model was verified using nonlinear support vector machine (SVM) and generalized linear model (GLM) and age and four miRNA qRT-PCR analysis values (dCt) were input to these models. Breast cancer risk scores for each Breast Imaging-Reporting and Data System (BI-RADS) category in multi-microRNA analysis were analyzed to examine the correlation between breast cancer risk scores and mammography categories. We generated two models using two classification algorithms, SVM and GLM, with a combination of four miRNA biomarkers showing high performance and sensitivities of 84.5% and 82.1%, a specificity of 85%, and areas under the curve (AUCs) of 0.967 and 0.965, respectively, which showed consistent performance across all stages of breast cancer and patient ages. The results of this study showed that this multi-microRNA analysis using the four miRNA biomarkers was effective in classifying breast cancer in patients under the age of 50, which is challenging to accurately diagnose. In addition, breast cancer and benign breast diseases can be classified, showing the possibility of helping with diagnosis by mammography. Verification of the performance of the four miRNA biomarkers confirmed that multi-microRNA analysis could be used as a new breast cancer screening aid to improve the accuracy of mammography. However, many factors must be considered for clinical use. Further validation with an appropriate screening population in large clinical trials is required. This trial is registered with (KNUCH 2022-04-036).

Standardized cotton swab sampling with nested quantitative polymerase chain reaction is effective for diagnosing ordinary scabies

BACKGROUND

Low sensitivity of the polymerase chain reaction (PCR) assay for diagnosing scabies has been pointed out due to the difficulty in obtaining tissue containing S. scabiei DNA.

OBJECTIVES

To evaluate nested real-time quantitative PCR (nRT-qPCR) with non-expert dependent standardized cotton swab sampling (CSW) as a tool for diagnosing scabies.

METHODS

All patients underwent dermoscopic and microscopic examination (MS) with scraped samples (Sc). Patient samples were acquired with a single, dry swab rubbed across the flexor areas of both wrists as well as the 8 interdigital spaces and on any suspected scabies lesions. nRT-qPCRs were performed with scraped and CSW samples.

RESULTS

Out of 125 patients with suspected scabies, 120 patients were sampled, and 57 were positive (MS positive n=53, nRT-qPCR with Sc positive n=52, nRT-qPCR with CSW positive n=46) and 63 were negative for scabies. The sensitivities of these tests were 93.0%, 91.2% and 80.7%, respectively, which were not different statistically (p > 0.05). However, upon subsequent monitoring after treatment, the sensitivity of nRT-qPCR with CSW was only 36.6%, which was significantly lower than 83.0% for MS and 92.7% for nRT-qPCR with Sc (p = 0.00, respectively). The obtained sequences showed 97% to 100% homology with scabies sequences deposited in GenBank.

CONCLUSIONS

CSW with nRT-qPCR shows sensitivity close to microscopic examination with scraping performed by experts as diagnosing scabies in an outpatient setting, but not for post-treatment monitoring. CSW with nRT-qPCR may be useful for physicians unfamiliar with a traditional diagnostic method, and for screening an outbreak in community facilities.

SOCS1 counteracts ROS-mediated survival signals and promotes apoptosis by modulating cell cycle to increase radiosensitivity of colorectal cancer cells

As negative regulators of cytokine signaling pathways, suppressors of cytokine signaling (SOCS) proteins have been reported to possess both pro-tumor and anti-tumor functions. Our recent studies have demonstrated suppressive effects of SOCS1 on epithelial to mesenchymal signaling in colorectal cancer cells in response to fractionated ionizing radiation or oxidative stress. The objective of the present study was to determine the radiosensitizing action of SOCS1 as an anti-tumor mechanism in color-ectal cancer cell model. In HCT116 cells exposed to ionizing radiation, SOCS1 over-expression shifted cell cycle arrest from G2/M to G1 and promoted radiation-induced apoptosis in a p53-dependent manner with down-regulation of cyclin B and up-regulation of p21. On the other hand, SOCS1 knock-down resulted in a reduced apoptosis with a decrease in G1 arrest. The regulatory action of SOCS1 on the radiation response was mediated by inhibition of radiation-induced Jak3/STAT3 and Erk activities, thereby blocking G1 to S transition. Radiation-induced early ROS signal was responsible for the activation of Jak3/Erk/STAT3 that led to cell survival response. Our data col-lectively indicate that SOCS1 can promote radiosensitivity of colorectal cancer cells by counteracting ROS-mediated survival signal, thereby blocking cell cycle progression from G1 to S. The resulting increase in G1 arrest with p53 activation then contributes to the promotion of apoptotic response upon radiation. Thus, induction of SOCS1 expression may increase therapeutic efficacy of radiation in tumors with low SOCS1 levels.

SOCS1 counteracts ROS-mediated survival signals and promotes apoptosis by modulating cell cycle to increase radiosensitivity of colorectal cancer cells

As negative regulators of cytokine signaling pathways, suppressors of cytokine signaling (SOCS) proteins have been reported to possess both pro-tumor and anti-tumor functions. Our recent studies have demonstrated suppressive effects of SOCS1 on epithelial to mesenchymal signaling in colorectal cancer cells in response to fractionated ionizing radiation or oxidative stress. The objective of the present study was to determine the radiosensitizing action of SOCS1 as an anti-tumor mechanism in colorectal cancer cell model. In HCT116 cells exposed to ionizing radiation, SOCS1 over-expression shifted cell cycle arrest from G2/M to G1 and promoted radiation-induced apoptosis in a p53-dependent manner with down-regulation of cyclin B and up-regulation of p21. On the other hand, SOCS1 knock-down resulted in a reduced apoptosis with a decrease in G1 arrest. The regulatory action of SOCS1 on the radiation response was mediated by inhibition of radiation-induced Jak3/STAT3 and Erk activities, thereby blocking G1 to S transition. Radiation-induced early ROS signal was responsible for the activation of Jak3/Erk/STAT3 that led to cell survival response. Our data collectively indicate that SOCS1 can promote radiosensitivity of colorectal cancer cells by counteracting ROS-mediated survival signal, thereby blocking cell cycle progression from G1 to S. The resulting increase in G1 arrest with p53 activation then contributes to the promotion of apoptotic response upon radiation. Thus, induction of SOCS1 expression may increase therapeutic efficacy of radiation in tumors with low SOCS1 levels. [BMB Reports 2022; 55(4): 198-203].

Evaluation of the Value of Multiplex MicroRNA Analysis as a Breast Cancer Screening in Korean Women under 50 Years of Age with a High Proportion of Dense Breasts

This study was conducted to confirm the performance of the microRNA (miRNA) biomarker combination as a new breast cancer screening method in Korean women under the age of 50 with a high percentage of dense breasts. To determine the classification performance of a set of miRNA biomarkers (miR-1246, 202, 21, and 219B) useful for breast cancer screening, we determined whether there was a significant difference between the breast cancer and healthy control groups through box plots and the Mann–Whitney U-test, which was further examined in detail by age group. To verify the classification performance of the 4 miRNA biomarker set, 4 classification methods (logistic regression, random forest, XGBoost, and generalized linear model plus random forest) were applied, and 10-fold cross-validation was used as a validation method to improve performance stability. We confirmed that the best breast cancer detection performance was achievable in patients under 50 years of age when the set of 4 miRNAs were used. Under the age of 50, the 4 miRNA biomarkers showed the highest performance with a sensitivity of 85.29%, specificity of 93.33%, and area under the curve (AUC) of 0.961. Examining the results of 4 miRNA biomarkers was found to be an effective strategy for diagnosing breast cancer in Korean women under 50 years of age with dense breasts, and hence has the potential as a new breast cancer screening tool. Further validation in an appropriate screening population with large-scale clinical trials is required.

Effectiveness of Cytochrome c Oxidase Subunit 1 Gene Nested Polymerase Chain Reaction Compared to Dermoscopy or Microscopy Alone for the Detection and Diagnosis of Sarcoptes scabiei var. hominis Infection

Background

Background: While microscopy (MS) evaluation of skin scrapings has a 100% positive predictive value and specificity by definition for scabies diagnosis, it has low sensitivity. Dermoscopy (DS) has not yet been widely accepted for diagnosis, and long-term clinician training is required.

Objective

To evaluate the diagnostic validity of cytochrome c oxidase subunit 1 (cox1) gene nested polymerase chain reaction (PCR) as an adjunctive method for diagnosing scabies.

Methods

This was a prospective, single institution study, conducted on a total of 302 skin lesions from 50 patients suspected of scabies at Kangdong Sacred Heart Hospital in Seoul, Korea. DS, MS, and cox1 nested PCR were performed on all patients.

Results

Of the 302 lesions, 145 (48.0%) were obtained at first visit and 157 (52.0%) were identified in the course of follow-up visits after treatment. For all lesions, DS and MS sensitivity levels were 55.9% (73/136) and 55.2% (75/136), respectively, with cox1 gene nested PCR considered as 100%. The results of DS and MS identification showed no difference between each other and showed significant difference from that of cox1 gene nested PCR.

Conclusion

Nested PCR detecting cox1 may be prospectively used to comprehensively diagnose lesions of scabies in clinical practice.

Diagnostic value of combining tumor and inflammatory biomarkers in detecting common cancers in Korea

BACKGROUND

The ultimate goal of cancer screening is to diagnose invasive cancers early, while they are still curable. We aimed to validate the diagnostic value of blood-derived protein biomarkers that we developed for six common cancer in Korea.

METHODS

We have discovered 12 protein biomarkers that are useful in differentiating cancer patients from healthy controls using two-dimensional gel electrophoresis (2-DE), surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS), and literature review. Cancer patients (stomach, colon, liver, lung, breast, and prostate) and control subjects were collected and tested data sets were used to generate predictive models that identify risk scores for each cancer. The validation study was done in serum samples of an independent patient cohort Receiver operating characteristic (ROC) analyses were conducted to evaluate the diagnostic performance of the biomarkercombinations.

RESULTS

The AUCs of the model in the test set were 0.971, 0.960, 0.969, 0.942, 0.834, and 0.985 for stomach, colon, liver, lung, breast, and prostate cancer, respectively.

CONCLUSIONS

Combining multiple tumor and systemic inflammatory biomarkers proved to be a valid strategy in the diagnosis of six common cancers in Korea. Further validation of appropriate screening populations through large-scale clinical trials are warranted.

Association between erythema nodosum/ erythema induratum of Bazin and Mycobacterium tuberculosis infection in Koreans

BACKGROUND

Erythema nodosum and erythema induratum of Bazin are similar inflammatory diseases of the lower extremities. These are clinically distinguishable entities, though overlap can occur. Both diseases are reported to be related to Mycobacterium tuberculosis infection, but it is very difficult to identify Mycobacterium tuberculosis in skin lesions.

AIM

This study aimed to develop a new nested polymerase chain reaction targeting the IS6110 insertion sequence of M. tuberculosis to improve the M. tuberculosis detection rate in skin lesions of erythema nodosum or erythema induratum of Bazin.

METHODS

From May 2016 to Jan 2018, 14 patients with clinically suspicious erythema nodosum or erythema induratum were enrolled in the study. Two cases were classified as erythema nodosum and 12 as erythema induratum. Individual patients were subjected to a 4-mm punch biopsy, and their venous whole blood was sampled immediately after diagnosis.

RESULTS

Eight patients were tested for M. tuberculosis using QuantiFERON, of which seven (87.5%) were positive. IS6110-nested polymerase chain reaction on all 14 patients identified 11 (78.6%) positive cases. Four of the eight (50%) individuals tested with QuantiFERON were also positive in the IS6110 nested polymerase chain reaction. The difference between the outcomes of the QuantiFERON and the IS6110-nested polymerase chain reaction tests was not statistically significant. There was also no significant agreement between the results of both assays. Sequencing the IS6110-nested polymerase chain reaction products showed a 97%-100% nucleotide sequence identity with the H37Rv genome.

CONCLUSION

It is important to test for tuberculosis in patients with multiple tender subcutaneous nodules on their lower extremities in high-burden tuberculosis countries like Korea.

LIMITATIONS

We need to register more suspicious patients to verify the association between erythema nodosum/erythema induratum of Bazin and M. tuberculosis. Furthermore, it is necessary to improve the more sensitive polymerase chain reaction technique to identify M. tuberculosis directly in cutaneous lesions.

Photoproduction of the f_{2}(1270) Meson Using the CLAS Detector

The quark structure of the f_{2}(1270) meson has, for many years, been assumed to be a pure quark-antiquark (qq[over ¯]) resonance with quantum numbers J^{PC}=2^{++}. Recently, it was proposed that the f_{2}(1270) is a molecular state made from the attractive interaction of two ρ mesons. Such a state would be expected to decay strongly to final states with charged pions due to the dominant decay ρ→π^{+}π^{-}, whereas decay to two neutral pions would likely be suppressed. Here, we measure for the first time the reaction γp→π^{0}π^{0}p, using the CEBAF Large Acceptance Spectrometer detector at Jefferson Lab for incident beam energies between 3.6 and 5.4 GeV. Differential cross sections, dσ/dt, for f_{2}(1270) photoproduction are extracted with good precision due to low backgrounds and are compared to theoretical calculations.

Beam Spin Asymmetry in Semi-Inclusive Electroproduction of Hadron Pairs

A first measurement of the longitudinal beam spin asymmetry A_{LU} in the semi-inclusive electroproduction of pairs of charged pions is reported. A_{LU} is a higher-twist observable and offers the cleanest access to the nucleon twist-3 parton distribution function e(x). Data have been collected in the Hall-B at Jefferson Lab by impinging a 5.498-GeV electron beam on a liquid-hydrogen target, and reconstructing the scattered electron and the pion pair with the CLAS detector. One-dimensional projections of the A_{LU}^{sinϕ_{R}} moments are extracted for the kinematic variables of interest in the valence quark region. The understanding of dihadron production is essential for the interpretation of observables in single-hadron production in semi-inclusive DIS, and pioneering measurements of single-spin asymmetries in dihadron production open a new avenue in studies of QCD dynamics.

Multiple microRNAs as biomarkers for early breast cancer diagnosis

MicroRNA (miRNA or miR) is stably present in plasma. It has been reported that miRNA could be used for detecting cancer. Circulating miRNAs are being increasingly recognized as powerful biomarkers in a number of different pathologies, including in breast cancer. The aim of the current study was to establish and validate miRNA sets that are useful for the early diagnosis of breast cancer. Specifically, the current study intended to determine whether miRNA biomarkers were tumor-specific and to statistically verify whether circulating miRNA analysis could be used for breast cancer diagnosis. In the present study, a total of nine candidate miRNA biomarkers were selected by examining reference miRNAs associated with the generation and progression of breast cancer to identify novel miRNAs that could be used to detect early breast cancer. A total of 226 plasma samples from patients with breast cancer were used. In addition, 146 plasma healthy samples were used as non-cancer controls. These samples were divided into training and validation cohorts. The training cohort was used to identify a combination of miRNA that could detect breast cancer. The validation cohort was used to validate this combination of miRNA. Total RNAs were isolated from collected samples. A total of 9 miRNAs were quantified using reverse-transcription quantitative PCR. A total of nine candidate miRNA expression levels were compared between patients with breast cancer and healthy controls. It was indicated that combinations of two or more of the nine miRNAs could detect breast cancer with higher accuracy than the use of a single biomarker. As a representative example, combinations of four miRNAs (miR-1246+miR-206+miR-24+miR-373) of the nine miRNAs had a sensitivity of 98%, a specificity of 96% and an accuracy of 97% for breast cancer detection in the validation cohort. The results of the present study suggest that multiple miRNAs could be used as potential biomarkers for early diagnosis of breast cancer. These biomarkers are expected to overcome limitations of mammography when used as an auxiliary diagnosis of mammography.

Extraction of Beam-Spin Asymmetries from the Hard Exclusive π^{+} Channel off Protons in a Wide Range of Kinematics

We have measured beam-spin asymmetries to extract the sinϕ moment A_{LU}^{sinϕ} from the hard exclusive e[over →]p→e^{'}nπ^{+} reaction above the resonance region, for the first time with nearly full coverage from forward to backward angles in the center of mass. The A_{LU}^{sinϕ} moment has been measured up to 6.6  GeV^{2} in -t, covering the kinematic regimes of generalized parton distributions (GPD) and baryon-to-meson transition distribution amplitudes (TDA) at the same time. The experimental results in very forward kinematics demonstrate the sensitivity to chiral-odd and chiral-even GPDs. In very backward kinematics where the TDA framework is applicable, we found A_{LU}^{sinϕ} to be negative, while a sign change was observed near 90° in the center of mass. The unique results presented in this Letter will provide critical constraints to establish reaction mechanisms that can help to further develop the GPD and TDA frameworks.

Discovery of Novel Recurrent Mutations and Clinically Meaningful Subgroups in Nodal Marginal Zone Lymphoma

Nodal marginal zone lymphoma (NMZL) is a rare B-cell neoplasm, the genetic and transcriptomic landscape of which are unclear. Using high-throughput sequencing for whole-exome and transcriptome, we investigated the genetic characteristics of NMZL in a discovery cohort (n = 8) and validated their features in an extended cohort (n = 30). Novel mutations in NFKBIE and ITPR2 were found in 7.9% (3/38) and 13.9% (5/36), respectively, suggesting roles for the NF-κB pathway and B-cell-receptor-mediated calcium signaling pathway in the pathogenesis of NMZL. RNA-seq showed that NMZLs were characterized by an aberrant marginal zone differentiation, associated with an altered IRF4-NOTCH2 axis and the enrichment of various oncogenic pathways. Based on gene expression profile, two subgroups were identified. Compared with subgroup 1, subgroup 2 showed the following: the significant enrichment of cell cycle-associated and MYC-signaling pathways, a more diverse repertoire of upstream regulators, and higher Ki-67 proliferation indices. We designated two subgroups according to Ki-67 labeling, and subgroup 2 was significantly associated with a shorter progression-free survival (p = 0.014), a greater proportion of large cells (p = 0.009), and higher MYC expression (p = 0.026). We suggest that NMZL has unique features and, in this study, we provide information as to the heterogeneity of this enigmatic entity.

Biomarker Panel for the Diagnosis of Pancreatic Ductal Adenocarcinoma

A single tumor marker has a low diagnostic value in pancreatic cancer. Combinations of multiple biomarkers and unique analysis algorithms can be applied to overcome these limitations. This study sought to develop diagnostic algorithms using multiple biomarker panels and to validate their performance in the diagnosis of pancreatic ductal adenocarcinoma (PDAC). We used blood samples from 180 PDAC patients and 573 healthy controls. Candidate markers consisted of 11 markers that are commonly expressed in various cancers and which have previously demonstrated increased expression in pancreatic cancer. Samples were divided into training and validation sets. Five linear or non-linear classification methods were used to determine the optimal model. Differences were identified in 10 out of the 11 markers tested. We identified 2047 combinations, all of which were applied to 5 separate algorithms. The new biomarker combination consisted of 6 markers (ApoA1, CA125, CA19-9, CEA, ApoA2, and TTR). The area under the curve, specificity, and sensitivity were 0.992, 95%, and 96%, respectively, in the training set. Meanwhile, the measures were 0.993, 96%, and 93% in the validation set. This study demonstrated the utility of multiple biomarker combinations in the early detection of PDAC. A diagnostic panel of 6 biomarkers was developed and validated. These algorithms will assist in the early diagnosis of PDAC.

Clinicopathological features of programmed cell death-1 and programmed cell death-ligand-1 expression in the tumor cells and tumor microenvironment of angioimmunoblastic T cell lymphoma and peripheral T cell lymphoma not otherwise specified

The expression patterns of programmed cell death-1 (PD-1) and programmed cell death-ligand-1 (PD-L1) and their clinicopathological implications were investigated in peripheral T cell lymphoma (PTCL) including angioimmunoblastic T cell lymphoma (AITL) and PTCL-not otherwise specified (PTCL-NOS). PTCL-NOS was further classified into nodal PTCL with follicular helper T cell (Tfh) phenotype ("PTCL-Tfh_new") and "PTCL-NOS_new". PD-1 and PD-L1 expression on tumor cells and reactive immune cells was evaluated using immunohistochemistry. PD-1 and PD-L1 expression on tumor cells (PD-1^T and PD-L1^T, respectively) was interpreted as positive when more than 5% of tumor cells expressed PD-1 or PD-L1. For PD-1 and PD-L1 on tumor cells and/or reactive immune cells (PD-1^T + IC and PD-L1^T + IC, respectively), a cutoff of 10% of cells was used. PD-1^T, PD-L1^T, and PD-L1^T + IC expressions tended to be higher in AITLs than in PTCLs-NOS. PD-1^T, PD-1^T + IC, PD-L1^T, and PD-L1^T + IC expressions tended to be higher in PTCLs with Tfh phenotype including AITLs and "PTCL-Tfh_new" than in PTCLs without Tfh phenotype. The serum LDH level was significantly elevated in patients with PTCL positive for PD-L1^T (P = 0.006) and PD-L1^T + IC (P < 0.001). Patients with PTCL who were positive for combined expression of PD-1^T/PD-L1^T + IC presented at older ages (P = 0.010), nodal diseases (P = 0.001), higher IPI (P = 0.060), and elevated LDH (P = 0.030). Combined PD-1^T/PD-L1^T + IC positivity was related to shorter overall survival in patients with AITL (P = 0.051). Combined PD-1^T/PD-L1^T + IC positivity was a significant poor prognostic factor in patients with stage IV AITL, independent of B symptoms and performance status (HR = 6.282 [CI, 1.655-23.844], P = 0.007). In summary, the PD-1/PD-L1 pathway could be a potential prognostic and therapeutic biomarker for PTCL.

Subclinical thyroid dysfunction, bone mineral density, and osteoporosis in a middle-aged Korean population

Thyroid dysfunction is associated with the loss of bone density (osteoporosis). However, the connection between subclinical thyroid dysfunction and osteoporosis remains controversial. This study found no apparent association between subclinical hypothyroidism or subclinical hyperthyroidism and bone mineral density (BMD) in the lumbar spine and femur.

INTRODUCTION

The present study examined the relationship between subclinical thyroid dysfunction and BMD in healthy middle-aged adults.

METHODS

A total of 25,510 healthy Koreans with normal free thyroxine levels were enrolled from January 2011 to December 2016, and 91% of subjects visited only once. The average age of the 15,761 women was 45, and the average age of the 9749 men was 48. Levels of thyroid-stimulating hormone (TSH) and BMD were recorded in all subjects. BMD was measured using dual-energy X-ray absorptiometry.

RESULTS

No apparent association was found between subclinical thyroid dysfunction and BMD in the lumbar spine, femur-neck, and proximal femur sites compared with a euthyroid group. Age, body mass index (BMI), and postmenopausal status affected BMD in women, and only BMI affected BMD in men. Subclinical hypothyroidism was independently associated with a lower risk of osteoporosis (odds ratio 0.657, 95% confidence interval 0.464-0.930) in 4710 postmenopausal women.

CONCLUSIONS

No apparent association was found between subclinical hypothyroidism or subclinical hyperthyroidism defined on single TSH measurement and BMD at the lumbar spine and femur in a large cohort of middle-aged men and women. Subclinical hypothyroidism was independently associated with a lower risk of osteoporosis in postmenopausal women.

Exploring the Structure of the Bound Proton with Deeply Virtual Compton Scattering

In the past two decades, deeply virtual Compton scattering of electrons has been successfully used to advance our knowledge of the partonic structure of the free proton and investigate correlations between the transverse position and the longitudinal momentum of quarks inside the nucleon. Meanwhile, the structure of bound nucleons in nuclei has been studied in inclusive deep-inelastic lepton scattering experiments off nuclear targets, showing a significant difference in longitudinal momentum distribution of quarks inside the bound nucleon, known as the EMC effect. In this Letter, we report the first beam spin asymmetry (BSA) measurement of exclusive deeply virtual Compton scattering off a proton bound in ^{4}He. The data used here were accumulated using a 6 GeV longitudinally polarized electron beam incident on a pressurized ^{4}He gaseous target placed within the CLAS spectrometer in Hall-B at the Thomas Jefferson National Accelerator Facility. The azimuthal angle (ϕ) dependence of the BSA was studied in a wide range of virtual photon and scattered proton kinematics. The Q^{2}, x_{B}, and t dependencies of the BSA on the bound proton are compared with those on the free proton. In the whole kinematical region of our measurements, the BSA on the bound proton is smaller by 20% to 40%, indicating possible medium modification of its partonic structure.

Clinical significance of rituximab infusion-related reaction in diffuse large B-cell lymphoma patients receiving R-CHOP

BACKGROUND/AIMS

This study was to evaluate the clinical significance of infusion-related reaction (IRR) of rituximab in diffuse large B-cell lymphoma (DLBCL) patients who received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) as a first-line chemotherapy.

METHODS

The medical records of 326 patients diagnosed with DLBCL were re trospectively analyzed. Both doctor's progress records and nursing records were reviewed. IRR was graded according to the National Cancer Institute Common Terminology Criteria.

RESULTS

IRR was not associated with overall survival (OS) or progression-free survival (PFS) of DLBCL patients as compared to those who did not have IRR (OS: median 78.0 months vs. 69.0 months, p = 0.700; PFS: median 65.4 months vs. 64.0 months, p = 0.901). IRR grade did not affect OS or PFS. B symptoms was independently associated with IRR (hazard ratio [HR], 1.850; 95% confidence interval [CI], 1.041 to 3.290; p = 0.036). Further, bone marrow involvement was independently associated with re-IRR (HR, 4.904; 95% CI, 0.767 to 3.118; p = 0.029).

CONCLUSION

Our study shows that IRR of rituximab is not associated with OS or PFS of DLBCL patients who received R-CHOP. Furthermore, our study suggests a need for more careful observation for IRR in patients with B symptoms or bone marrow involvement.

Switching to tenofovir vs continuing entecavir for hepatitis B virus with partial virologic response to entecavir: a randomized controlled trial

Entecavir 0.5 mg (ETV) is widely used among treatment-naïve chronic hepatitis B (CHB) patients. However, 10%-30% of patients show partial virologic response (PVR) to the drug. If the hepatitis B virus (HBV) continues to replicate, the underlying liver disease may progress. Herein, we compared the efficacy of switching to tenofovir disoproxil fumarate (TDF) with that of continuing ETV in CHB patients with PVR to ETV. This was an open-label randomized controlled trial including CHB patients who had been receiving 0.5 mg of ETV for >12 months, but who still had detectable HBV DNA levels of >60 IU/mL without known resistance to ETV. Sixty patients were enrolled and 45 qualified for the study: Twenty-two patients were randomly assigned into the TDF group and 23 into the ETV group. After 12 months of treatment, the virologic response rate (HBV DNA <20 IU/mL) was significantly higher in the TDF group than in the ETV group, as measured using per-protocol analysis (55% vs 20%; P = .022) and intention-to-treat analysis (50% vs 17.4%; P = .020). The reduction in HBV DNA was greater (-1.13 vs -0.67 log₁₀ IU/mL; P = .024), and the mean HBV DNA level was lower (1.54 vs 2.01 log₁₀ IU/mL; P = .011) in the TDF group than in the ETV group. In conclusion, to achieve optimal response in CHB patients with PVR to ETV, switching to TDF would be a better strategy than continuing ETV. Appropriate modification of therapy would further improve the outcome of chronic HBV infection.

Early development of de novo hepatocellular carcinoma after direct-acting agent therapy: Comparison with pegylated interferon-based therapy in chronic hepatitis C patients

Patients with chronic hepatitis C who achieve a sustained viral response after pegylated interferon therapy have a reduced risk of hepatocellular carcinoma, but the risk after treatment with direct-acting antivirals is unclear. We compared the rates of early development of hepatocellular carcinoma after direct-acting antivirals and after pegylated interferon therapy. We retrospectively analysed 785 patients with chronic hepatitis C who had no history of hepatocellular carcinoma (211 treated with pegylated interferon, 574 with direct-acting antivirals) and were followed up for at least 24 weeks after antiviral treatment. De novo hepatocellular carcinoma developed in 6 of 574 patients receiving direct-acting antivirals and in 1 of 211 patients receiving pegylated interferon. The cumulative incidence of early hepatocellular carcinoma development did not differ between the treatment groups either for the whole cohort (1.05% vs 0.47%, P = .298) or for those patients with Child-Pugh Class A cirrhosis (3.73% vs 2.94%, P = .827). Multivariate analysis indicated that alpha-fetoprotein level >9.5 ng/mL at the time of end-of-treatment response was the only independent risk factor for early development of hepatocellular carcinoma in all patients (P < .0001, hazard ratio 176.174, 95% confidence interval 10.768-2882.473) and in patients treated with direct-acting agents (P < .0001, hazard ratio 128.402, 95% confidence interval 8.417-1958.680). In conclusion, the rate of early development of hepatocellular carcinoma did not differ between patients treated with pegylated interferon and those treated with direct-acting antivirals and was associated with the serum alpha-fetoprotein level at the time of end-of-treatment response.

The efficacy of a nested polymerase chain reaction in detecting the cytochrome c oxidase subunit 1 gene of Sarcoptes scabiei var. hominis for diagnosing scabies

BACKGROUND

A widespread scabies infestation, associated with long-term residence in nursing homes, is becoming an issue in high-income countries. Mineral oil examination is regarded as the gold standard in diagnosing scabies, but the sensitivity of this method is generally low - approximately 50%. Molecular techniques may contribute to enhancing the sensitivity of current tests for laboratory diagnosis of human scabies.

OBJECTIVES

To develop new primers for a nested polymerase chain reaction (PCR) for the cytochrome c oxidase subunit 1 (cox1) gene of Sarcoptes scabiei var. hominis to increase the sensitivity of a previously developed conventional PCR.

METHODS

Patients with clinically suspected scabies underwent dermoscopy-guided skin scraping with microscopic examination. The diagnosis was positive for scabies when mites or eggs were found under the microscope, and patients were then designated as 'microscopy positive'. Patients who presented with negative microscopic results were placed in the 'microscopy-negative' group. Skin scrapings were collected from both groups for PCR.

RESULTS

Of the total 63 samples, 28 were microscopy positive and 35 were negative with no differences in sex and age between the two groups. All microscopically proven cases of scabies were positive using the cox1 nested PCR. Among microscopy-negative samples, S. scabieiDNA was detected in nine. If sensitivity of the cox1 nested PCR is considered 100% [95% confidence interval (CI) 90·5-100], then sensitivity of microscopy is 75·7% (95% CI 58·8-88·2; P = 0·004).

CONCLUSIONS

Nested PCR can be successfully used as an alternative method for diagnosing suspected scabies. Therefore, infection control measures and treatments can be initiated before significant transmission occurs, minimizing the risk of outbreaks.

Prognostic implications of tumor-infiltrating macrophages, M2 macrophages, regulatory T-cells, and indoleamine 2,3-dioxygenase-positive cells in primary diffuse large B-cell lymphoma of the central nervous system

Primary diffuse large B-cell lymphoma of the central nervous system (CNS-DLBCL) is an aggressive disease with a poor prognosis. The status of the tumor immune microenvironment in CNS-DLBCL remains unclear. We investigated the prognostic implications of tumor-associated macrophages (TAMs), regulatory T-cells (Tregs), and indoleamine 2,3-dioxygenase (IDO)⁺ cells in primary CNS-DLBCL (n = 114) by immunohistochemical analysis. The numbers of tumor-infiltrating immune cells, including CD68⁺ TAMs, CD163⁺ or CD204⁺ M2 macrophages, FOXP3⁺ Tregs, and IDO⁺ cells were all significantly lower in CNS-DLBCL versus systemic DLBCL (n = 165; all P < 0.001), but with little difference in the ratio of CD163⁺/CD68⁺ or CD204⁺/CD68⁺ cells. An increase in CD68⁺ cell numbers was significantly associated with prolonged progression-free survival (PFS) and overall survival in patients with CNS-DLBCL (P = 0.004 and 0.021, respectively). In contrast, an increase in CD204⁺ cell numbers or a higher ratio of CD204⁺/CD68⁺ cells was related to a shorter PFS (P = 0.020 and 0.063, respectively). An increase in IDO⁺ cell numbers was associated with a significantly longer PFS (P = 0.019). In combination, the status of low IDO⁺ cell numbers combined with low CD68⁺ cell numbers, high CD204⁺ cell numbers, or a high CD204⁺/CD68⁺ cell ratio all predicted poor PFS in multivariate analyses. This study showed that an increase in CD204⁺ cell numbers, suggestive of M2 macrophages, was associated with poor clinical outcome in CNS-DLBCL, whereas increased CD68⁺ or IDO⁺ cell numbers were related to a favorable prognosis. The analysis of tumor-infiltrating immune cells could help in predicting the prognosis of CNS-DLBCL patients and determining therapeutic strategies targeting tumor microenvironment.

The Effect of Animation-Assisted Informed Consent Using Tablet Personal Computer for Contrast-Enhanced Computed-Tomography in Emergency Department

Introduction

Informed consent is essential patient's right even in overcrowded emergency department (ED). We compared the effect of animation-assisted informed consent using tablet PC with the standard informed consent for contrast-enhanced computed-tomography (CT) in ED.

Methods

We included 150 patients scheduled to undergo contrast-enhanced CT in ED from November 2010 through January 2011. Participants were randomised to either animation-assisted information (AAI) (n=75) or standard verbal information (SVI) group (n=75). AAI was provided by tablet personal computer (PC); and SVI by clinicians. All participants completed 10-point scale questionnaires after the CT scan. The questionnaires included two main categories – understanding and satisfaction of informed consent.

Results

Participants in the AAI group had a better understanding of purpose (8.95±1.48 vs. 8.32±1.88, p=0.026) and methods (8.93±1.43 vs. 8.37±1.83, p=0.048) of CT scans compared to participants in the SVI group. Every score in satisfaction categories was significantly higher in the AAI group. In the SVI group, relatively low-educated participants had a lower score in understanding when compared with university-educated participants (7.53±2.28 vs. 8.52±1.40, p=0.029). Regardless of education level, understanding score was high in the AAI group (8.73±1.27 vs. 8.57±1.50, p=0.71).

Conclusions

Participants receiving animation assisted informed consent with tablet PC shows a higher degree of understanding and satisfaction compared with patients receiving standard verbal informed consent. Particularly in patients with lower education, animation-assisted informed consent may be better for understanding of contrast-enhanced CT.

Preparedness of Young Male Physicians for Biological Terrorism and Warfare in South Korea

Introduction

The events of 11th September 2001, and the subsequent anthrax attacks in the United States brought the threat of bioterrorism to the forefront of concern for public health departments. Moreover, the rising confrontation between North and South Korea emphasizes the possibility of aggression with biological weapons and our vulnerability to bioterrorism. While the importance of physicians' interests and management ability is becoming more critical, no studies have yet been undertaken in Korea to assess whether primary care physicians are well informed and capable of managing bioterrorism. This study evaluates the awareness and response of young male physicians to potential bioterrorism in South Korea.

Method

A total of 692 young male physicians completed the knowledge and awareness survey during the education period of military service on 9th April 2005.

Results

Forty-five percent of the participants responded that the possibility of biological warfare in Korea was high. The level of bioterrorism knowledge, however, was low. Eighty-seven percent acknowledged the necessity of education and training for bioterrorism, and 69.9% were willing to accept education and training in bioterrorism preparedness.

Conclusion

These findings suggest that young physicians should receive continuous education and training to improve preparedness for biological terrorism and warfare in South Korea.

An Analysis of Escalator-Related Injuries in an Emergency Department

Background

Escalator-related injuries have been considered uncommon and most likely to occur in children. In this study, we described the epidemiology of these injuries with focus on the aged population in order to determine whether escalators are safe for the aged, and to obtain information to help in preventing escalator-related injuries.

Methods

A prospective survey was taken to identify the number and nature of these injuries from May 2004 to December 2008. We enrolled patients who had sustained escalator-related injuries. A standard list of questions and answers were recorded by the emergency physician. A total of 104 questionnaires were completed during the study period.

Results

The average patient age was 59.2±24.0 years (range 1-94). There were 64 (61.5%) females. Only 11 (10.6%) were younger than 15 years old, and 59 (56.7%) were aged 65 or above; 35 (59.3%) of the aged people were injured while standing on the escalator. However, out of the 45 patients younger than age 65, 22 (48.9%) were injured from walking on a moving escalator. Head injury was the commonest site of injury overall and all were due to fall or slipping down.

Conclusions

Escalator-related injuries are not as rare as previously believed and the aged population 65 years old or above is the highest risk group. In particular, walking on a moving escalator was the main cause of injury in people under age 65. Therefore, primary prevention strategies are needed to prevent users from walking on escalators, especially young people, and educate aged people the safe utilization of escalators to prevent slip and fall injuries.

Haemopericardium and Liver Laceration Associated with Airbag Deployment

Airbags and seat belts are safety devices in automobiles. First invented in the 1950s, they are now commonplace in most automobiles. However, a seat occupant may sustain unexpected injuries even if the airbag deploys in a car collision. We describe a patient who was suspected of simultaneously sustaining haemopericardium and liver laceration during the “punch out” and “membrane force” phases of airbag deployment. The patient's vital signs stabilised after an emergency pericardiocentesis was performed. In a car accident when high-energy injury is suspected despite airbag deployment, computed tomography of the chest and abdomen or echocardiography should be considered because of the possibility of abdominal solid organ and chest injury.

Deep Venous Thrombosis Caused by a Huge Uterine Myoma

Cases of deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) related to the isolated risk factor of uterine myoma are very rare. In a setting of emergency department (ED), it is unlikely that uterine myoma would be suspected as the primary cause of symptoms in a patient with thromboembolism. We presented a 44-year-old woman who visited the ED for DVT presenting with right lower leg swelling with an underlying cause of a huge uterine myoma. Various aetiologies, including obstetric and gynaecological causes (especially uterine myoma), should be considered in female patients visiting the ED with suspected DVT or PTE.

Does the Bed Frame Deflection Occur along with Mattress Deflection during In-Hospital Cardiopulmonary Resuscitation? an Experiment Using Mechanical Devices

Objectives

When we perform chest compression on a patient on a bed, the mattress and bed frame can be depressed together with the patient's chest. This study was conducted to assess whether bed frame deflection occurred during chest compressions.

Methods

We designed a firm bed (“bed like the ground,” BLG) to assess the bed frame deflection in the Stryker Trauma Stretcher (STS) and the ER stretcher cart (ER-SC). The STS included a soft mattress and the ER-SC a hard mattress. We performed 50 continuous chest compressions on the Resusci Anne Skill Reporter with CPRmeter in each experiment. The experiments were done in four settings. Test 1 included the BLG; test 2 included a mattress and backboard on each bed; test 3 included the mattress of each bed and a backboard on the BLG; and test 4 included the mattress of each bed on the BLG. We calculated the mattress and bed frame deflections using the gaps of compression depths between the values measured by Resusci Anne and CPRmeter.

Results

The mattress deflections of the STS and ER-SC mattress were determined to be 11.2 and 0.67 mm, respectively. The bed frame deflection for the STS and ER-SC were 0.95 and 5.17 mm, respectively.

Conclusion

The study confirms that bed frame deflection will occur when we perform chest compressions on the manikin lying on a bed. Additionally, the bed frame deflections differ depending on the type of bed. (Hong Kong j.emerg.med. 2016;23:35-41)

Is There Any Difference in Cardiopulmonary Resuscitation Performance According to Different Instructional Models of Cardiopulmonary Resuscitation Education for Junior and Senior High School Students?

Objective

This study aims to determine whether or not cardiopulmonary resuscitation (CPR) skills differ according to different instructional models for CPR education and training for junior and senior high school students.

Methods

This was a prospective and randomised study including 519 junior and senior high school students. After the lecture on CPR, students practiced the skill on the manikin. Group 1 used model 1 and Group 2 used model 2 for practical training and practical skills and CPR performance quality were evaluated.

Results

Data from skill tests were analysed in 229 students in group 1 and 210 students in group 2. The total score of sequence skill tests was 17.8±2.0 points. During 2 cycles, no chest elevation was observed in 33.3% and was significantly lower in group 1. There were no significant differences in the frequency of proper ventilation and in ventilation volume between the 2 groups. Excessive ventilation was more frequently observed in group 1 and insufficient ventilation was observed more frequently in group 2. The percentage of the frequency of a proper chest compression rate was 80.5±31.2% and there were no significant differences in proper and insufficient depths, mean rate and recoil of the chest in chest compression between the 2 groups.

Conclusions

There were differences in CPR skills according to different CPR training manikins. Therefore, certain conditions seem to be considered in selection of instructional models for CPR psychomotor skills. (Hong Kong j.emerg.med. 2011;18:375-382)

Cervical Emphysema and Pneumomediastinum following “Light Strangulation” Injury

Pneumomediastinum is an uncommon radiographic finding resulting from various causes, such as trauma, infection and unknown causes. The pneumomediastinum due to minor trauma is rarely reported and treatment and diagnostic process is not established. We report on a 20-year-old female patient who initially presented with neck pain and dyspnoea following manual strangulation. Her chest X-ray and computed tomography (CT) of neck imaging showed subcutaneous emphysema and extensive pneumomediastinum, but pneumothorax was not shown. She was transferred to the thoracic surgery and admitted to the general ward. The patient's condition improved and she was discharged on the sixth hospital day. In conclusion, patients with pneumomediastinum following a minor strangulation injury can be observed alone without invasive testing or repeated imaging. CT scans are of great value for safe observation in determined patients and for the further evaluation of pneumomediastinum.

Plasma Cell Cheilitis: A Clinicopathological and Immunohistochemical Study of 13 Cases

Background

Plasma cell cheilitis is an unusual benign plasma cell proliferative disease of an unknown etiology that typically presents on the lip.

Objective

The aim of this study was to investigate the clinicopathological characteristics of 13 cases of plasma cell cheilitis.

Methods

The present study investigated the clinical manifestations, treatment modalities, and outcome of 13 patients diagnosed with plasma cell cheilitis from 2011 to 2016 at Kangdong Sacred Heart Hospital and Hallym University Sacred Heart Hospital. Biopsy specimens of the all cases were evaluated using conventional hematoxylin and eosin staining with kappa and lambda immunoglobulin light chain immunohistochemistry.

Results

The age of the patients ranged from 39 to 86 years (mean, 64.7 years), with male predominance. Histopathologically, 61.5% and 38.5% of patients showed band-like and pan dermal plasmacytic infiltrates, respectively. Eosinophilic infiltration was noted in 69.2% of patients. All cases showed both kappa and lambda immunoglobulin light chain reactivities, and kappa predominance was confirmed in 9 patients (69.2%). A majority of the patients was treated with local therapy, such as intralesional steroid injection with topical tacrolimus. Among the 13 patients, plasma cell cheilitis completely resolved, partially resolved, and recurred in 3 (23.1%), 5 (38.5%), and 5 patients (38.5%), respectively.

Conclusion

Plasma cell cheilitis presented as erosive edematous circumscribed patches or plaques affecting mainly the lower lip of elderly male patients. The majority of histopathology cases showed characteristic plasma cell aggregation on the upper dermis that was immunopositive for immunoglobulin light chain, with kappa predominance.

Frequency of Herpes Zoster Recurrence in Central District of Korea

Background

Herpes zoster is characterized by unilateral grouped vesicles along the distribution of a dermatome. A global recurrence rate as low as 0.5%∼6.2% has been reported for herpes zoster. The recurrence of herpes zoster is higher in immunocompromised patients and older patients.

Objective

The purpose of this study is to assess the frequency of herpes zoster recurrence and factors that can influence its recurrence.

Methods

From January 2005 to December 2015, 14,343 patients with herpes zoster were enrolled in this study. The patients were diagnosed at Hallym University Medical Centers and Kangwon National University Hospital in Seoul, Gyeonggi, and Gangwon. Herpes zoster recurrence and patient characteristics were surveyed by medical record review and a telephonic survey.

Results

The overall frequency of herpes zoster recurrence was 1.18%. The frequency of recurrence was higher in women than in men. It was also higher in patients aged 50∼70 years than in patients who were younger or older than this. Additionally, we assessed that the frequency of recurrence was statistically higher in patients with a compromised immune system and in patients who experienced longer lasting pain during their first episode.

Conclusion

The frequency of herpes zoster recurrence is more common in women, older age, patient with longer pain duration and immunocompromised patients.