Performances of serum creatinine, C-reactive protein and white blood cell to predict urinary tract infection in febrile children younger than 24 months of age

Purpose Differentiation of urinary tract infection (UTI) from viral infection is a critical challenge in febrile children in emergency departments (EDs). This study aimed to assess the predicting performances of creatinine, C-reactive protein (CRP), and white blood cell (WBC) for predicting UTI in the children. Methods This study was a retrospective analysis of a prospectively enrolled cohort of febrile children who presented to our children’s hospital ED from August 2016 through February 2018. We included previously healthy, febrile (≥ 38。C) children younger than 24 months whose urine cultures were obtained. Accuracy of creatinine, CRP, and WBC were assessed by optimal cutoffs, which were calculated using receiver operating characteristic curves. Results Among the total 33,013 children to the ED, 7,847 (23.8%) febrile children were registered to the fever registry. Finally, 506 children were included, and UTI was diagnosed in 127 (25.1%). The areas under the curve of creatinine, CRP, and WBC to predict UTI were 0.41 (95% confidence interval [CI], 0.35-0.46), 0.71 (95% CI, 0.66-0.77), and 0.66 (95% CI, 0.60-0.72), respectively. The cutoffs were 0.26 mg/dL for creatinine, 2.3 mg/dL for CRP, and 14.4 × 103 cells/μL for WBC. Creatinine showed worse performance than the other variables. The application of creatinine added to the other variables led to an increase only in the sensitivity, but at the expense of a lower specificity, positive predictive value, and negative predictive value. Conclusion Serum creatinine showed a poor performance in predicting UTI in the febrile young children. Since a single biomarker can neither rule in nor rule out UTI in the children, the prediction of UTI can be achieved by the interpretation of both clinical and laboratory findings

Cordycepin promotes apoptosis by modulating the ERK-JNK signaling pathway via DUSP5 in renal cancer cells

Constitutive activation of extracellular signal regulated kinase (ERK)-Jun NH2-terminal kinase (JNK) signaling commonly occurs in tumors. The activation of ERK promotes cell proliferation, whereas that of JNK induces cell apoptosis. However, the apoptotic mechanism of ERK-JNK signaling in cancer is not well understood. Recently, we identified that apoptosis and activation of the JNK signaling pathway were induced after cordycepin treatment in human renal cancer, suggesting that JNK signaling might contribute to TK-10 cell apoptosis. We investigated the apoptotic effects of cordycepin by evaluating the activation of the ERK-JNK signaling pathway in renal cancer TK-10 cells. We found that cordycepin downregulated ERK and DUSP5, upregulated phosphorylated-JNK (p-JNK), and induced apoptosis. Moreover, we showed that siRNA-mediated inhibition of ERK downregulated DUSP5, whereas ERK overexpression upregulated DUSP5, and that DUSP5 knockdown by siRNA upregulated p-JNK. The JNK-specific inhibitor SP600125 upregulated nuclear translocation of β-catenin, and downregulated Dickkopf-1 (Dkk1), which has been shown to be a potent inhibitor of Wnt signaling. Dkk1 knockdown by siRNA upregulated nuclear β-catenin, suggesting the involvement of the Wnt/β-catenin signaling pathway. DUSP5 overexpression in TK-10 cells decreased p-JNK and increased nuclear β-catenin. The decreased Bax activation markedly protected against cordycepin-induced apoptosis. Bax subfamily proteins induced apoptosis through caspase-3. Taken together, we show that JNK signaling activation by cordycepin mediated ERK inhibition, which might have induced Bax translocation and caspase-3 activation via regulation of DUSP5 in TK-10 cells, thereby promoting the apoptosis of TK-10 cells. Targeting ERK-JNK signaling via the apoptotic effects of cordycepin could be a potential therapeutic strategy to treat renal cancer

Application of a Cumulative Summation test (CUSUM)in the Lumbar Spine

Study design: Retrospective analysisObjectives: The aim of this study was to monitor the quality control of pedicle screw fixation using a cumulativesummation test (CUSUM).Overview of Literature: CUSUM test has already been used in several different surgical settings including theassessment of outcomes in transplant, laparoscopic, and total hip replacement surgeries. However, there has been nodata regarding CUSUM analysis for spine surgery.Methods: Patients with lumbar spinal stenosis who underwent lumbar fusion surgery were included in this study.The primary outcome was the CUSUM analysis for monitoring the quality control of the accuracy of pedicle screwinsertion.Results: Seven screws of the 100 pedicle screw insertions were considered to have failed in the lumbar fusion surgery,respectively. Throughout the monitoring period, there was no indication by the CUSUM test that the quality ofperformance of the pedicle screw fixation procedure was inadequate.Conclusions: Thisstudy demonstrates the CUSUM test can be a useful tool for monitoring of the quality of proceduresrelated with spine surgery.OAIID:oai:osos.snu.ac.kr:snu2014-01/102/0000004226/7SEQ:7PERF_CD:SNU2014-01EVAL_ITEM_CD:102USER_ID:0000004226ADJUST_YN:NEMP_ID:A079510DEPT_CD:801CITE_RATE:0DEPT_NM:의학과SCOPUS_YN:NCONFIRM:

Gene Co-expression Analysis to Characterize Genes Related to Marbling Trait in Hanwoo (Korean) Cattle

Marbling (intramuscular fat) is an important trait that affects meat quality and is a casual factor determining the price of beef in the Korean beef market. It is a complex trait and has many biological pathways related to muscle and fat. There is a need to identify functional modules or genes related to marbling traits and investigate their relationships through a weighted gene co-expression network analysis based on the system level. Therefore, we investigated the co-expression relationships of genes related to the ‘marbling score’ trait and systemically analyzed the network topology in Hanwoo (Korean cattle). As a result, we determined 3 modules (gene groups) that showed statistically significant results for marbling score. In particular, one module (denoted as red) has a statistically significant result for marbling score (p = 0.008) and intramuscular fat (p = 0.02) and water capacity (p = 0.006). From functional enrichment and relationship analysis of the red module, the pathway hub genes (IL6, CHRNE, RB1, INHBA and NPPA) have a direct interaction relationship and share the biological functions related to fat or muscle, such as adipogenesis or muscle growth. This is the first gene network study with m.logissimus in Hanwoo to observe co-expression patterns in divergent marbling phenotypes. It may provide insights into the functional mechanisms of the marbling trait

Endoscopic Pancreatic Sphincterotomy: Indications and Complications

Background/Aims: Although a few recent studies have reported the effectiveness of endoscopic pancreatic sphincterotomy (EPST), none has compared physicians' skills and complications resulting from the procedure. Thus, we examined the indications, complications, and safety of EPST performed by a single physician at a single center. Methods: Among 2,313 patients who underwent endoscopic retrograde cholangiopancreatography between January 1996 and March 2008, 46 patients who underwent EPST were included in this retrospective study. We examined the indications, complications, safety, and effectiveness of EPST, as well as the need for a pancreatic drainage procedure and the concomitant application of EPST and endoscopic sphincterotomy (EST). Results: Diagnostic indications for EPST were chronic pancreatitis (26 cases), pancreatic divisum (4 cases), and pancreatic cancer (8 cases). Therapeutic indications for EPST were removal of a pancreaticolith (10 cases), stent insertion for pancreatic duct stenosis (9 cases), nasopancreatic drainage (7 cases), and treatment of sphincter of Oddi dysfunction (1 case). The success rate of EPST was 95.7% (44/46). Acute complications of EPST included five cases (10.9%) of pancreatitis and one of cholangitis (2.2%). EPST with EST did not reduce biliary complications. Endoscopic pancreatic drainage procedures following EPST did not reduce pancreatic complications. Conclusions: EPST showed a low incidence of complications and a high rate of treatment success; thus, EPST is a relatively safe procedure that can be used to treat pancreatic diseases. Pancreatic drainage procedures and additional EST following EPST did not reduce the incidence of procedure-related complications

Identification of Recently Selected Mutations Driven by Artificial Selection in Hanwoo (Korean Cattle)

Hanwoo have been subjected over the last seventy years to intensive artificial selection with the aim of improving meat production traits such as marbling and carcass weight. In this study, we performed a signature of selection analysis to identify recent positive selected regions driven by a long-term artificial selection process called a breeding program using whole genome SNP data. In order to investigate homozygous regions across the genome, we estimated iES (integrated Extended Haplotype Homozygosity SNP) for the each SNPs. As a result, we identified two highly homozygous regions that seem to be strong and/or recent positive selection. Five genes (DPH5, OLFM3, S1PR1, LRRN1 and CRBN) were included in this region. To go further in the interpretation of the observed signatures of selection, we subsequently concentrated on the annotation of differentiated genes defined according to the iES value of SNPs localized close or within them. We also described the detection of the adaptive evolution at the molecular level for the genes of interest. As a result, this analysis also led to the identification of OLFM3 as having a strong signal of selection in bovine lineage. The results of this study indicate that artificial selection which might have targeted most of these genes was mainly oriented towards improvement of meat production

A case of emphysematous hepatitis with spontaneous pneumoperitoneum in a patient with hilar cholangiocarcinoma

An 80-year-old woman with hilar cholangiocarcinoma was hospitalized due to sudden-onset abdominal pain. Computed tomography revealed hepatic necrosis accompanied with emphysematous change in the superior segment of the right liver (S7/S8), implying spontaneous rupture, based on the presence of perihepatic free air. Although urgent percutaneous drainage was performed, neither pus nor fluids were drained. These findings suggest emphysematous hepatitis with a hepatic mass. Despite the application of intensive care, the patient's condition deteriorated rapidly, and she died 3 days after admission to hospital. Liver gas has been reported in some clinical diseases (e.g., liver abscess) to be caused by gas-forming organisms; however, emphysematous hepatitis simulating emphysematous pyelonephritis is very rare. The case reported here was of fatal emphysematous hepatitis in a patient with hilar cholangiocarcinoma

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

개방형 경골 근위부 절골술 후 관상면 하지 정렬 기여인자의 변화 : 관절간격의 변화가 수술 후 하지 정렬에 미치는 영향

학위논문 (석사)-- 서울대학교 대학원 : 의학과, 2017. 2. 장종범.Background We aimed 1) to assess 3 major variables [femoral condylar orientation (FCO), tibia plateau inclination (TPI) and knee joint space tilt angle (JTA)] which would mainly contribute to overall limb alignment in patients undergoing medial open-wedge high tibial osteotomy(HTO) and compare the variables with those of normal knees, 2) to assess the changes of the 3 variables after HTO, and to compare the actual correction amount with the amount computed based on the two planning methods (Dugdale and Miniach methods), 3) to find the factors associated with the amount of JTA changes, and 4) to find factors associated with categories of final alignment after HTO. Materials and Methods We assessed 66 patients undergoing open-wedge HTO (HTO group) and 160 normal knees (control group). The weight loading line (WLL), FCO, TPI, and JTA were measured on whole limb standing anteroposterior (AP) radiographs in all the subjects preoperatively. Additionally, same measurement was performed in the HTO group postoperatively, then the differences of the variables between the pre- and post-HTO were calculated. The amount of correction based on the two planning methods (Dugdale and Miniach methods) were computed, and compared with the actual correction angle calculated using TPI difference. In terms of categories of final alignment, WLL ratio within ±5% from the target WLL were classified as ideal correction, more than +5% as overcorrection and less than -5% as undercorrection. The factors associated with amount of JTA change by HTO were analyzed using the multivariate regression analyses with backward method, and the factor associated with over- and/or undercorrection was investigated using logistic regression analyses. Results Compared with the control group, all the variables were more varus than the HTO group, preoperatively (P < 0.001 in all). Particularly, JTA of the HTO group was more than 3 fold of that of the control group (4.1° vs. 1.2°, P < 0.001). After HTO, besides the change of TPI, JTA also decreased by 2 degree on average. The amount of JTA change was larger in patients with more preoperative varus alignment and larger preoperative JTA, preoperatively (B = -0.19, P = 0.006, and B = -0.28, P = 0.001, respectivelyR2 for regression model = 0.361). In comparison between Dugdale and Miniach methods, the correction amount computed by Miniachi method was significantly larger than by Dugdale method (8.6° and 9.7°, P = 0.028). Between the two methods, angle computed by Dugdale method was more close to actual amount of correction (8.6° vs. 8.9°, respectively). In terms of categories of final alignment, 37 knees (56%) were classified as ideal correction and 29 knees (44%) as overcorrection. There was no knee classified as undercorrection. Among the radiographic variables evaluated except postoperative WLL, the change of JTA differed significantly between the ideal correction group and the overcorrection group (1.5° and 3.0° respectively, P < 0.001). Conditional logistic regression analysis showed that an overcorrection was associated with the amount of JTA changes (odds ratio = 3.04, P = 0.002). Conclusion We found that three major variables determining overall coronal alignment was more varus in the HTO group than the control group. Particularly, JTA of the HTO group significantly contributed to the varus limb alignment, and the JTA decreased by 2° on average after HTO which could result in additional valgus realignment effect after HTO. Even though more preoperative varus alignment and more preoperative tilt of JTA were found to be associated with larger change of the JTA after HTO, accurate estimation of the JTA change may not be possible due to low R2 value. Planning of target angle by Miniachi method showed significantly larger angle than that of Dugdale method. Therefore, if JTA change was not considered, Miniachi method could increase risk of overcorrection after HTO. Development of new method which could estimate the change of JTA more accurately would be warranted via further studies. 배경 본 연구는 개방형 경골 근위부 절골술을 시행받는 환자에서 1) 관상면 하지 정렬에 기여하는 3가지 주요 변수를 평가하고, 2) 수술 후 3가지 변수의 변화 및 실제 교정 각도와 술 전 Dugdale 방법과 Miniach 방법을 이용하여 계산한 계획 각도의 차이를 비교하며, 3) 술 후 관절간격의 기울기의 변화 정도와 관련된 인자들을 분석하고, 4) 수술 후 하지의 최종 정렬 상태와 연관된 인자를 알아보고자 한다. 대상 및 방법 내측 개방형 경골 근위부 절골술을 시행받은 66명의 환자와 정상 대조군으로 160명의 환자를 대상으로 하여 연구를 진행하였다. 기립 전하지 전후면 방사선 사진을 이용하여 체중 부하선과, 원위 대퇴 경사도, 경골 고평부 경사도, 슬관절간격의 기울기를 측정하였고, 환자군에서 수술 전 상태와 수술 후 상태, 그리고 환자군에서 수술 전 상태와 정상 대조군의 상태를 비교하였다. 수술 후 슬관절간격의 기울기에 변화에 기여하는 인자들에 대해 분석을 시행하였다. 또한, 수술 전 Dugdale 방법과 Miniach 방법을 이용하여 교정각도를 계산하였고, 이를 실제 교정된 각도와 비교하였다. 수술 후 체중 부하선이 원래 목표했던 체중 부하선과의 차이가 5% 이내인 경우를 적절한 교정으로 보았고, 목표했던 체중 부하선에 비해 5% 이상 외반인 경우를 과교정, 5% 이상 내반인 경우를 저교정으로 정의하였으며, 이상교정된 경우에 이에 기여하는 인자들에 대해 분석하였다. 결과 정상 대조군과 비교하였을 때 3가지 변수가 환자군에서 모두 유의하게 내반되어 있었다. 특히 관절간격의 기울기는 대조군에 비해 3배가 넘는 차이를 보였다. (환자군: 4.1°, 대조군 : 1.2°, P<0.001) 수술 후에는 경골 고평부 경사도의 변화 외에도 관절간격의 기울기가 평균 2도 감소하였다. 수술 전 교정각도의 계산을 위한 Dugdale 방법과 Miniach 방법을 비교하였을 때, Miniachi 방법으로 계산한 교정각이 Dugdale 방법으로 계산한 값에 비해 유의하게 컸다.(각각 9.7° 와 8.6°, p = 0.028). 또한 실제 교정각도는 8.9°로 Dugdale 방법으로 계산한 값에 더 근접하였다. 관절간격의 기울기는 수술 전에 내반 정도가 클수록 그리고, 수술 전 관절간격의 기울기가 더 내반되어 있을수록 수술 후의 그 변화량이 더 큰 경향을 보였다(β = -0.19, p = 0.006 and β = -0.28, p = 0.001, respectivelyR2 for regression model = 0.361). 수술 후 정렬 상태를 평가하였을 때 총 29 명의 환자(44%)에서 과교정이 되었으며, 저교정된 환자는 없었다. 적절하게 교정된 군과 과교정된 군간에 인구학적 요소들과 하지의 정렬에 기여하는 해부학적 인자들에는 유의한 차이가 없었으나, 관절간격의 기울기의 변화량에는 유의한 차이가 있었으며, 과교정된 군에서 그 변화량이 유의하게 더 컸다(각각 1.5° 와 3.0°, p<0.001). 회귀분석을 시행하였을 때, 관절간격의 기울기 변화량이 클수록 과교정의 위험도가 유의하게 증가하였다(Odds ratio = 3.04, p = 0.002) 결론 본 연구에서는 대조군에 비하여 환자군의 3가지 주요 관상면 정렬 기여 변수가 모두 다 내반되어 있었으며, 특히 관절간격의 기울기가 환자군에서 내반 정렬에 상대적으로 큰 기여를 하고 있음을 알 수 있었다. 내측 개방형 경골 근위부 절골술 후에 관절간격의 기울기가 감소하여 결국 평균 2도의 추가적인 외반 교정효과가 발생함을 알 수 있었으며, 이는 수술 전 내반 변형의 정도와 관절간격의 기울기와 연관이 있었다. 하지만 추정 회귀식의 수정된 결정 계수 값이 낮아 관절간격 기울기 변화를 만족스럽게 예측할 수는 없었다. 수술 전 교정각도를 계산할 때 Miniachi의 방법으로 계산한 값이 Dugdale 방법으로 계산한 값보다 유의하게 컸으며, 이론적으로는 Miniachi 방법이 더 타당해 보이지만 관절간격의 기울기를 고려하지 않는 경우 과교정의 위험이 더 큰 것으로 사료된다. 따라서, 과교정의 위험성을 조금이나마 줄이기 위해서는 관절간격의 변화에 대한 고려가 필요하다. 향후 관절간격의 기울기의 변화를 보다 정확하게 추정할 수 있는 방법에 대한 연구가 필요할 것으로 사료된다.Introduction 1 Materials and Methods 8 Results 20 Discussions 26 Conclusions 30 References 31 Abstract (Korean) 39Maste