John Jeongseok Yang

Mean platelet volume/platelet count ratio in hepatocellular carcinoma

Mean platelet volume (MPV) has been actively investigated in liver disease such as steatosis, cirrhosis and hepatitis. Recently, MPV/platelet count (PC) ratio has been proposed as a predictor of long-term mortality after myocardial infarction. As PC is known to be decreased in various liver diseases such as cirrhosis, hepatosplenomegaly and malignancy, we planned to evaluate MPV/PC ratio in patients with hepatocellular carcinoma (HCC) in this study. Mean of MPV levels showed significant difference, which were 8.69 fl (range 6.7–12.2 fl) in patients group and 8.02 fl in control group (range 6.7–11.0 fl). In receiver operating characteristic (ROC) curve analysis, the MPV/PC ratio (fl/(109/l)) presented 74.5% of sensitivity and 96.5% of specificity at the criterion > 0.0491 (area under the curve (AUC) = 0.884), while MPV alone showed 57.4% of sensitivity and 81.4% of specificity at the criterion > 8.4 fl. Further studies should evaluate underlying pathogenic mechanisms of MPV/PC ratio difference and various possibilities of this ratio as an indicator of presence of a tumor in HCC.

Combined Bacillus licheniformis and Bacillus subtilis infection in a patient with oesophageal perforation

Species of the genus Bacillus are a common laboratory contaminant, therefore, isolation of these organisms from blood cultures does not always indicate infection. In fact, except for Bacillus anthracis and Bacillus cereus, most species of the genus Bacillus are not considered human pathogens, especially in immunocompetent individuals. Here, we report an unusual presentation of bacteraemia and mediastinitis due to co-infection with Bacillus subtilis and Bacillus licheniformis, which were identified by 16S RNA gene sequencing, in a patient with an oesophageal perforation.

Factors influencing discordant results of the QuantiFERON-TB Gold In-tube test in patients with active TB

OBJECTIVES Indeterminate or negative results from the QuantiFERON-TB Gold In-tube test (QFT-GIT) for TB-confirmed patients indicate the lower sensitivity of this method. The aim of this study was to determine the factors associated with indeterminate and negative QFT-GIT results in active TB patients. METHODS We analyzed retrospectively the laboratory and clinical data of patients diagnosed with TB between December 2009 and April 2012 at a tertiary university hospital in Seoul, Korea. RESULTS Among 1301 patients who underwent QFT-GIT, TB-PCR and TB-culture, 168 (12.9%), those with positive TB-PCR or TB-culture were diagnosed with TB. Thirty-nine (23.2%) had indeterminate or negative results by QFT-GIT assay, which did not correlate with positive results of TB-PCR or TB-culture. These patients were older, had lower lymphocyte, total protein and albumin levels, and showed significantly higher CRP levels than the positive group. Multivariate logistic regression analysis showed that the probability of indeterminate and negative QFT-GIT results increased as CRP (odd ratio, 1.069; 95% CI, 1.013-1.127; P = 0.014) or age (1.030, 1.005-1.056, 0.02) increases. CONCLUSIONS When levels of markers of inflammation, such as CRP, are high or the patient is older, QFT-GIT results should be interpreted carefully and correlated with additional tests for TB.

Submicroscopic Deletion of FGFR1 Gene Is Recurrently Detected in Myeloid and Lymphoid Neoplasms Associated with ZMYM2-FGFR1 Rearrangements: A Case Study

a Department of Laboratory Medicine, School of Medicine, Kyung Hee University, b Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul , Departments of c Laboratory Medicine and d Pathology, Inje University College of Medicine, Busan , and e School of Life Science and Biotechnology, Kyungpook National University, Daegu , Republic of Korea; f Institute of Pharmaceutical Biology, ZAFES, Diagnostic Center of Acute Leukemia, Goethe University of Frankfurt, Frankfurt/Main , Germany

Evaluation of a Chromogenic Culture Medium for the Detection of Clostridium difficile

Purpose Clostridium difficile (C. difficile) is an important cause of nosocomial diarrhea. Diagnostic methods for detection of C. difficile infection (CDI) are shifting to molecular techniques, which are faster and more sensitive than conventional methods. Although recent advances in these methods have been made in terms of their cost-benefit, ease of use, and turnaround time, anaerobic culture remains an important method for detection of CDI. Materials and Methods In efforts to evaluate a novel chromogenic medium for the detection of C. difficile (chromID CD agar), 289 fecal specimens were analyzed using two other culture media of blood agar and cycloserine-cefoxitin-fructose-egg yolk agar while enzyme immunosorbent assay and polymerase chain reaction-based assay were used for toxin detection. Results ChromID showed the highest detection rate among the three culture media. Both positive rate and sensitivity were higher from chromID than other culture media. ChromID was better at detecting toxin producing C. difficile at 24 h and showed the highest detection rate at both 24 h and 48 h. Conclusion Simultaneous use of toxin assay and anaerobic culture has been considered as the most accurate and sensitive diagnostic approach of CDI. Utilization of a more rapid and sensitive chromogenic medium will aid in the dianogsis of CDI.

Mean platelet volume in acute appendicitis: A gender difference

Mean platelet volume (MPV) is an index of platelet production and activation which reflects the changes in platelet size in various conditions [1–8]. Although, MPV is an easily obtainable index from automated hematology analyzers, it has rather been overlooked until its associations with various diseases are continuously being reported recently. MPV is known to be decreased in diseases of acute pancreatitis, ulcerative colitis, rheumatoid arthritis and ankylosing spondylitis [9–11] as well as local inflammatory conditions including acute appendicitis (AA) due to migration and consumption of highly reactive large platelets into sites of inflammation [12]. AA is a common surgical emergency requiring timely intervention while its diagnosis can be elusive [13]. Association between AA and MPV was first suggested by Albayrak and colleagues followed by Lee and Kim also evaluating the MPV in AA, although this platelet index was found unable to discriminate AA and ectopic pregnancy [14], [15]. To compare MPV levels in AA with other acute abdomen with gynecologic backgrounds, such as ectopic pregnancy, the presence of gender difference in MPV levels should be elucidated preferentially. In this study, we planned to investigate MPV levels in AA and perform the further analysis according to gender groups. From January 2011 to December 2011, at a tertiary-setting teaching hospital in Korea, we evaluated 196 patients diagnosed with AA of their MPV value. Individuals who visited for medical check-ups were reviewed of their medical charts to exclude history of diabetes, hypertension or smoking, enrolling 143 individuals as control group. Complete blood count results at the time of their arrival to the emergency department were obtained, which were analyzed by Advia 2120 (Siemens Healthcare Diagnostics Inc., Tarrytown, NY). All samples were analyzed within 2 hours using EDTA containing vacutainer bottles, obtained by venipuncture. Through laparoscopic appendectomy and also appendectomy in some cases, specimens were obtained for histopathological examination. Patients were retrospectively reviewed of their medical records and only those with confirmed histopathological results as AA were included. Histopathological results of obtained specimens were mostly acute suppurative appendicitis (84.7%). Thirty cases of acute suppurative appendicitis with perforation (14.8%) and two cases of acute exudative appendicitis (0.5%) were also included. Statistical analyses were done using MedCalc v11.6 (MedCalc Software, Mariakerke, Belgium) and Excel 2007 (Microsoft Corporation, Redmond, WA). Independent sample t-test was used to compare the differences of two groups. From the comparison of 196 AA patients to 143 healthy controls, laboratory indices compared and characteristics of each group are described in Table I. The mean value of MPV in AA was 7.82 0.64 fL, being significantly lower than 7.96 0.58 fL of healthy controls (p1⁄4 0.042). It was a concordant result with the previous reports [14], [15]. It was intriguing to find that when groups were subdivided according to the gender, only the male group showed a statistically significant decrease in MPV (p1⁄4 0.009) while the female group did not (Figure 1). Gasparyan et al. [16] suggested two possible mechanisms of decreased MPV in high-grade inflammatory conditions. First is the overproduction of pro-inflammatory cytokines and acutephase reactants interfering with megakaryopoiesis which in turn results in subsequent release of small size platelets from the bone marrow. Second is the decreased size of circulating platelets resulting from intensive consumption of larger-sized platelets at sites of inflammation. Although MPV is an index of platelet production and differed among the two compared groups, the History

Mean platelet volume/platelet count ratio in anemia

Iron deficiency anemia (IDA) is the most prevalent micronutrient deficiency in the world, and the leading cause of anemia [1, 2]. IDA is due to a defect in hemoglobin (Hb) synthesis that results in microcytic red blood cells (RBC) and decreased amount of Hb [3]. In addition to changes in RBC indices, IDA is also known to cause mild to moderate thrombocytosis. While reactive thrombocytosis soon resolves after iron supplement, previous studies have suggested that thrombosis in IDA may occasionally results in clinical manifestation such as thrombotic events [4]. Although increased endogenous erythropoietin may play a role in thrombocytosis, mechanism of platelet production in irondeficiency induced thrombocytosis is yet to be fully understood and relevant platelet indices are not fully evaluated [5]. Recently, mean platelet volume (MPV) has been suggested as a useful platelet index for platelet function and activation [5–10]. Also, MPV/platelet count ratio has been proposed as a new parameter for the prediction of long-term mortality in patients with myocardial infarction [9]. In this context, we planned to investigate MPV and MPV/platelet count ratio according to serum iron status in patients with anemia. The study group included 330 specimens of which Hb levels were below 11.0 g/dL from patients group at Kyung Hee University Hospital, a tertiary teaching hospital, between January and December 2011. Because the standard biochemical markers of iron metabolism have been traditionally serum or plasma iron, total iron binding capacity (TIBC), and transferrin saturation (TfS), patients group was defined as shown in Figure 1. For the control group, 311 subjects for medical check-ups were enrolled from the same hospital, which had been used as control group in our previous reports [11, 12]. Mean age of patients group was 52.75, and male to female ratio was 153 : 177. Blood sample was obtained through venepuncture into ethylenediaminetetraacetic acid (EDTA)containing tubes and complete blood count (CBC) parameters were measured using Advia 2120 (Siemens Healthcare Diagnostics Inc., Tarrytown, NY, USA) within 2 hours. Serum iron and unbound-iron binding capacity was measured in Toshiba chemical analyzer (Toshiba, Nasushiobara, Japan), from which TIBC and TfS was calculated. ANOVA followed by post-hoc analysis were used to compare means and receiver operating characteristic (ROC) curve analysis was done to evaluate the diagnostic performance. A value of p< 0.05 was considered statistically significant. These statistical analyses were performed with MedCalc v11.6 (MedCalc Software, Mariakerke, Belgium) and Excel 2007 (Microsoft Corporation, Redmond, WA, USA). Mean of platelet count, MPV levels and MPV/platelet count ratio were significantly different among three groups, respectively. Platelet count was markedly increased in IDA patients group (mean 335.78 10/L) compared to a significantly lower level in non-IDA-anemia patients group (mean 198.71 10/L, p< 0.001). MPV displayed statistically significant differences in all three groups (Figure 2a). It was significantly higher in patients group of anemia other than IDA (mean 8.60 fL) than other two groups (mean of control group 8.02 fL, mean of IDA patients group 8.34 fL, respectively, p< 0.001) broadening the difference of MPV/ platelet count ratio between groups which showed to be more

Acute promyelocytic leukemia with trisomy 8 showing normal PML-RARA FISH signal patterns: diagnostic application of long-distance polymerase chain reaction in molecularly discrepant leukemia cases.

Dear Editor, In the recent published article “FISH-negative cryptic PMLRARA rearrangements detected by long-distance polymerase chain reaction and sequencing analyses: a case study and review of literature,” we have reviewed and listed most of the reported cases of cryptic PML-RARA rearrangements so far [1]. In this study, we report an additional rare case of PML-RARA fluorescence in situ hybridization (FISH)-negative acute promyelocytic leukemia (APL) associated with trisomy 8 and discuss briefly on the relatively high frequency of Korean APL patients showing cryptic PMLRARA rearrangements. This novel case was again analyzed and characterized at molecular level by applying longdistance polymerase chain reaction (LD-PCR). A 23-year-old male was referred to our hospital for further evaluation and treatment of ecchymosis and thrombocytopenia. Complete blood count results were: hemoglobin, 12.0 g/dL; platelet count, 36,000/μL; and white blood cell count, 3,940/μL. Leukemic blasts and promyelocytes accounted for 13% of total leukocytes. Bone marrow

Molecular characterization and clinical impact of t(11;15)(q23;q14–15) MLL-CASC5 rearrangement

The identification of novel translocation partner genes involved in MLL rearrangements increases the chances of identifying novel possibilities for a targeted, molecular therapy. Concerted efforts by many research groups in collaboration with the Diagnostic Center of Acute Leukemia (DCAL) at

Mean platelet volume in patients with increased procalcitonin level

Procalcitonin (PCT) is the precursor of hormone calcitonin, which plays a metabolic role in calcium homeostasis [1]. Every tissue of human body has the potential to produce PCT, and serum level of PCT is usually markedly increased in conditions such as sepsis, systemic infection and severe inflammation [1, 2]. Mean platelet volume (MPV) is known to be associated with platelet reactivity and function [3–6]. MPV has also been investigated in several infectious diseases such as HIV, malaria and hepatitis B. However, it was not fully investigated in systemic bacterial infections. Therefore, we planned to evaluate MPV in patients with significantly increased PCT. The study group included 322 specimens from 268 Korean patients in which PCT levels were above 1.0 ng/ml (reference limit<0.046 ng/ml) from the Kyung Hee University Hospital, a tertiary teaching hospital, between August and December 2011. To include patients with definitive infection, we enrolled patients to show increased PCT level above 20 folds of the upper reference limit. For the control group, 311 subjects for medical check-ups were enrolled from the same hospital, who were also used as a control group in our previous studies [3, 4]. The mean age of patient group was 64.77 (range 0–94 years), and male-to-female ratio was 188:134. The spectrum of underlying diseases was broad, from malignancy to benign inflammation. Blood sampling was performed through venepuncture and MPV was measured using Ethylenediaminetetraacetic acid (EDTA)containing tubes in Advia 2120 (Siemens Healthcare Diagnostics Inc., Tarrytown, NY, USA) within 2 hours. Serum PCT was measured using Elecsys BRAHMS PCT (Roche, Mannheim, Germany). Statistical significance was analyzed using the independent sample Student’s t-test, and p values <0.05 were considered statistically significant. These statistical analyses were performed with MedCalc v11.6 (MedCalc Software, Mariakerke, Belgium) and Excel 2007 (Microsoft Corporation, Redmond, WA, USA). In the patient group, means for serum PCT was 9.58 ng/ml (range 1.0–100.0 ng/ml) and for serum CRP was 8.21 mg/dl (range <0.3–28.70 mg/dl), respectively (Table I). The mean MPV level was significantly higher in the patient group, which was 8.51 fl (95% confidence interval: 8.39–8.62 fl, p< 0.001, Figure 1). Correlation between MPV and PCT did