Cervical Length and the Risk of Microbial Invasion of the Amniotic Cavity in Women with Preterm Premature Rupture of Membranes

The aims of this study were to determine whether sonographically measured cervical length is of value in the identification of microbial invasion of the amniotic cavity in women with preterm premature rupture of membranes (PPROM) and to compare its performance with maternal blood C-reactive protein (CRP), white blood cell count (WBC), and amniotic fluid (AF) WBC. This prospective observational study enrolled 50 singleton pregnancies with PPROM. Transvaginal ultrasound for measurement of cervical length was performed and maternal blood was collected for the determination of CRP and WBC at the time of amniocentesis. AF obtained by amniocentesis was cultured and WBC determined. The prevalence of a positive amniotic fluid culture was 26% (13/50). Patients with positive amniotic fluid cultures had a significantly shorter median cervical length and higher median CRP, WBC, and AF WBC than did those with negative cultures. Multiple logistic regression indicated that only cervical length had a significant relationship with the log odds of a positive AF culture. Transvaginal sonographic measurement of cervical length is valuable in the identification of microbial invasion of amniotic cavity in women with PPROM. Cervical length performs better than AF WBC, maternal blood CRP, and WBC in the identification of a positive amniotic fluid culture

Severe protein C deficiency in a newborn caused by a homozygous pathogenic variant in the PROC gene: a case report

Background Severe protein C deficiency is a rare and inherited cause of thrombophilia in neonates. Protein C acts as an anticoagulant, and its deficiency results in vascular thrombosis. Herein, we report a case of protein C deficiency with a homozygous pathogenic variant in a term neonate, with good outcomes after proper treatment. Case presentation A four-day-old male newborn was transferred to the Seoul National University Hospital on account of dark red to black skin lesions. He was born full-term with an average birth weight without perinatal problems. There were no abnormal findings in the prenatal tests, including intrauterine sonography. The first skin lesion was observed on his right toes and rapidly progressed to proximal areas, such as the lower legs, left arm, and buttock. Under the impression of thromboembolism or vasculitis, we performed a coagulopathy workup, which revealed a high D-dimer level of 23.05 μg/ml. A skin biopsy showed fibrin clots in most capillaries, and his protein C activity level was below 10%, from which we diagnosed protein C deficiency. On postnatal day 6, he experienced an apnea event with desaturation and an abnormal right pupillary light reflex. Brain computed tomography showed multifocal patchy intracranial hemorrhage and intraventricular hemorrhage with an old ischemic lesion. Ophthalmic examination revealed bilateral retinal traction detachments with retinal folds. Protein C concentrate replacement therapy was added to previous treatments including steroids, prostaglandin E1, and anticoagulation. After replacement therapy, there were no new skin lesions, and the previous lesions recovered with scarring. Although there were no new brain hemorrhagic infarctions, there was ongoing ischemic tissue loss, which required further rehabilitation. Ophthalmic surgical interventions were performed to treat the bilateral retinal traction detachments with retinal folds. Molecular analysis revealed a homozygous pathogenic variant in the PROC gene. Conclusion Severe protein C deficiency can manifest as a fatal coagulopathy in any organ. Early diagnosis and proper treatment, including protein C concentrate replacement, may improve outcomes without serious sequelae

A Case Report of a Poor Metabolizer of CYP2D6 Presented with Unusual Responses to Nortriptyline Medication

We present a case with decreased metabolic activity of CYP2D6, a cytochrome P450 enzyme catalyzing the metabolism of nortriptyline (NT). Conventional dosage regimen led to toxic plasma concentration of NT and adverse effects such as dry mouth, constipation, and dizziness in this case with genotype CYP2D6*5/*10B. This case suggests the clinical usefulness of pharmacogenetic testing in individualized dosage adjustments of NT

Classification of Focal Prostatic Lesions on Transrectal Ultrasound (TRUS) and the Accuracy of TRUS to Diagnose Prostate Cancer

Objective: To improve the diagnostic efficacy of transrectal ultrasound (TRUS)-guided targeted prostatic biopsies, we have suggested the use of a new scoring system for the prediction of malignancies regarding the characteristics of focal suspicious lesions as depicted on TRUS. Materials and Methods: A total of 350 consecutive patients with or without prostate cancer who underwent targeted biopsies for 358 lesions were included in the study. The data obtained from participants were randomized into two groups; the training set (n = 240) and the test set (n = 118). The characteristics of focal suspicious lesions were evaluated for the training set and the correlation between TRUS findings and the presence of a malignancy was analyzed. Multiple logistic regression analysis was used to identify variables capable of predicting prostatic cancer. A scoring system that used a 5-point scale for better malignancy prediction was determined from the training set. Positive predictive values for malignancy prediction and the diagnostic accuracy of the scored components with the use of receiver operating characteristic curve analysis were evaluated by test set analyses. Results: Subsequent multiple logistic regression analysis determined that shape, margin irregularity, and vascularity were factors significantly and independently associated with the presence of a malignancy. Based on the use of the scoring system for malignancy prediction derived from the significant TRUS findings and the interactions of characteristics, a positive predictive value of 80% was achieved for a score of 4 when applied to the test set. The area under the receiver operating characteristic curve (AUC) for the overall lesion score was 0.81. Conclusion: We have demonstrated that a scoring system for malignancy prediction developed for the characteristics of focal suspicious lesions as depicted on TRUS can help predict the outcome of TRUS-guided biopsies.This study was supported by the Seoul National University Bundang Hospital Research Fund (Grant No. 02-2006-031).Mitterberger M, 2007, J UROLOGY, V178, P464, DOI 10.1016/j.juro.2007.03.107Djavan B, 2007, WORLD J UROL, V25, P11, DOI 10.1007/s00345-007-0151-1Shim HB, 2007, TUMORI, V93, P178Toi A, 2007, J UROLOGY, V177, P516, DOI 10.1016/j.juro.2006.09.061Lee HJ, 2006, J ULTRAS MED, V25, P815Elabbady AA, 2006, EUR UROL, V49, P49, DOI 10.1016/j.eururo.2005.08.013Halpern EJ, 2005, CANCER, V104, P2373, DOI 10.1002/cncr.21440Ozden E, 2005, J CLIN ULTRASOUND, V33, P5, DOI 10.1002/jcu.20080Kuligowska E, 2001, RADIOLOGY, V220, P757Lavoipierre AM, 1998, AM J ROENTGENOL, V171, P205Plawker MW, 1997, J UROLOGY, V158, P1853Cornud F, 1997, UROLOGY, V49, P709NEWMAN JS, 1995, RADIOLOGY, V195, P86LITTRUP PJ, 1992, CA-CANCER J CLIN, V42, P198HAMPER UM, 1991, RADIOLOGY, V180, P101LEE F, 1991, CANCER, V67, P1132RIFKIN MD, 1988, RADIOLOGY, V166, P619

Climatic yield potential of Japonica???type rice in the Korean Peninsula under RCP scenarios using the ensemble of multi???GCM and multi???RCM chains

Rice production in the Korean Peninsula (KP) in the near future (2021-2050) is analysed in terms of the climatic yield potential (CYP) index for Japonica-type rice. Data obtained from the dynamically downscaled daily temperature and sunshine duration for the Historical period (1981-2010) and near future under two Representative Concentration Pathway (RCP4.5 and RCP8.5) scenarios are utilized. To reduce uncertainties that might be induced by using a Coupled General Circulation Model (CGCM)-a Regional Climate Model (RCM) chain in dynamical downscaling, two CGCM-three RCM chains are used to estimate the CYP index. The results show that the mean rice production decreases, mainly due to the increase of the temperature during the grain-filling period (40 days after the heading date). According to multi model ensemble, the optimum heading date in the near future will be approximately 12 days later and the maximum CYP will be even higher than in the Historical. This implies that the rice production is projected to decrease if the heading date is selected based on the optimum heading date of Historical, but to increase if based on that of near future. The mean rice production during the period of ripening is projected to decrease (to about 95% (RCP4.5) and 93% (RCP8.5) of the Historical) in the western and southern regions of the KP, but to increase (to about 104% (RCP4.5) and 106% (RCP8.5) of the Historical) in the northeastern coastal regions of the KP. However, if the optimum heading date is selected in the near future climate, the peak rice production is projected to increase (to about 105% (RCP4.5) and 104% (RCP8.5) of the Historical) in the western, southern and northeastern coastal regions of the KP, but to decrease (to about 98% (RCP4.5) and 96% (RCP8.5) of the Historical) in the southeastern coastal regions of the KP

Takayasu's Arteritis Treated by Percutaneous Transluminal Angioplasty with Stenting in the Descending Aorta

A 17-yr-old young woman was referred to our hospital with a 2-yr history of claudication of the lower extremities and severe arterial hypertension. Physical examination revealed significantly different blood pressures between both arms (160/92 and 180/95 mmHg) and legs (92/61 and 82/57 mmHg). The hematological and biochemical values were within their normal ranges, except for the increased erythrocyte sedimentation rate (83 mm/hr) and C-reactive protein (6.19 mg/L). On 3-dimensional computed tomographic angiography, the ascending aorta, the aortic arch and its branches, and the thoracic and, descending aorta, but not the renal artery, were shown to be stenotic. The diagnosis of type IIb Takayasu's arteritis was made according to the new angiographic classification of Takayasu's arteritis, Takyasu conference 1994. Percutaneous transluminal angioplasty with stenting was performed on the thoracic and abdominal aorta. After the interventional procedures, the upper extremity blood pressure improved from 162/101 mmHg to 132/85 mmHg, respectively. She has been free of claudication and there have been no cardiac events during 2-yr of clinical follow-up

Hearing Threshold of Korean Adolescents Associated with the Use of Personal Music Players

Purpose: Hearing loss can lead to a number of disabilities and can reduce quality of life. Noise-induced hearing losses have become more common among adolescents due to increased exposure to personal music players. We, therefore, investigated the use of personal music player among Korean adolescents and the relationship between hearing threshold and usage pattern of portable music players. Materials and Methods: A total of 490 adolescents were interviewed personally regarding their use of portable music players, including the time and type of player and the type of headphone used. Pure tone audiometry was performed in each subject. Results: Of the 490 subjects, 462 (94.3%) used personal music players and most of them have used the personal music player for 1-3 hours per day during 1-3 years. The most common type of portable music player was the MP3 player, and the most common type of headphone was the earphone (insert type). Significant elevations of hearing threshold were observed in males, in adolescents who had used portable music players for over 5 years, for those over 15 years in cumulative period and in those who had used earphones. Conclusion: Portable music players can have a deleterious effect on hearing threshold in adolescents. To preserve hearing, adolescents should avoid using portable music players for long periods of time and should avoid using earphones

Histone demethylase KDM5D drives sex-specific differences in colorectal cancer

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Drug-induced liver injury caused by iodine-131

Iodine-131 is a radioisotope that is routinely used for the treatment of differentiated thyroid cancer after total or near-total thyroidectomy. However, there is some evidence that iodine-131 can induce liver injury . Here we report a rare case of drug-induced liver injury (DILI) caused by iodine-131 in a patient with regional lymph node metastasis after total thyroidectomy. A 47-year-old woman was admitted with elevated liver enzymes and symptoms of general weakness and nausea. Ten weeks earlier she had undergone a total thyroidectomy for papillary thyroid carcinoma and had subsequently been prescribed levothyroxine to reduce the level of thyroid-stimulating hormone. Eight weeks after surgery she underwent iodine-131 ablative therapy at a dose of 100 millicuries, and subsequently presented with acute hepatitis after 10 days. To rule out all possible causative factors, abdominal ultrasonography, endoscopic ultrasonography (on the biliary tree and gall bladder), and a liver biopsy were performed. DILI caused by iodine-131 was suspected. Oral prednisolone was started at 30 mg/day, to which the patient responded well