Sang-Gyung Kim

Mean cell volumes of neutrophils and monocytes are promising markers of sepsis in elderly patients

Background Sepsis in elderly patients is a major cause of morbidity and mortality in the clinical setting. The aim of this study was to assess the diagnostic significance of volume conductivity scatter (VCS) parameters and to compare their reliability with that of inflammatory markers. Methods Patients (N=85) were divided into 3 groups according to their clinical history and culture results: control (N=29), localized infection (N=38), and sepsis (N=18). VCS parameters were obtained using a UniCel DxH 800 Coulter system. Cut-off values were established based on receiver operator characteristic (ROC) curves. Results The mean volumes of neutrophils (MNV) and monocytes (MMV) were higher in the sepsis group than in the localized infection and control groups (P=0.000 for both). The mean cell conductivity and low median angle light scatter of neutrophils were lower in the sepsis group than in the localized infection and control groups (P=0.029 and P=0.022, respectively). With a cut-off of 156.5, MNV had a sensitivity of 83.3% and a specificity of 78% in predicting sepsis. Conclusion MNV and MMV, which can be obtained easily using an automated blood analyzer, may be promising hematologic parameters for distinguishing elderly individuals with and without sepsis and may help clinicians in the diagnosis of sepsis.

Human leucocyte antigen‐B27 subtypes in Korean patients with ankylosing spondylitis: higher B*2705 in the patient group

Aim:  To investigate the distribution of human leucocyte antigen (HLA) class I antigens and B27 subtypings in a group of B27(+) ankylosing spondylitis (AS) patients and a group of B27(+) control individuals, and to compare differences in their clinical features using subtyping.

γδ T cells are increased in the peripheral blood of patients with gastric cancer.

BACKGROUND γδ T cells are implicated in immunoregulation. However, little is known about the characteristics of γδ T cells in gastric cancer. In this study, we assessed the incidence of γδ T cells and lymphocyte subsets in the peripheral blood of gastric cancer patients. METHODS We enrolled 48 patients and 49 healthy controls. The γδ T cells, lymphocyte subsets were analyzed with flow cytometry. RESULTS The mean percentage of γδ T cells in patients with gastric cancer was 5.0±3.4% and for controls 2.3±1.6%. Twenty (41.7%) of the 48 patients with gastric cancer had a high percentage (more than 5%) of peripheral blood γδ T cells, while 4 (8.2%) of the 49 controls did. The percentage of CD3⁺ T cells were elevated in gastric cancer compared to controls (P=0.007). The CD4/CD8 ratio increased in gastric cancer (P=0.311). The percentage of CD3⁺CD4⁻CD8⁻ T cells increased in gastric cancer compared to controls (P=0.004). CONCLUSION The proportion of γδ T cells in the peripheral blood of gastric cancer patients was significantly higher in comparison to that in the healthy controls. Our findings suggest that increased proportion of peripheral γδ T cells may explain anti-tumor immunity against gastric cancer partly.

Single-Center Experience of ABO-Incompatible Living-Donor Liver Transplantation With a New Simplified Intravenous Immunoglobulin Protocol: A Propensity Score-Matching Analysis

The outcomes of patients who undergo ABO-incompatible (ABO-I) living-donor liver transplantation (LDLT) have markedly improved as strategies have become more innovative and advanced. Here, we describe 25 cases of ABO-I LDLT with a simplified protocol and compare the outcomes to those of ABO-compatible LDLT. We analyzed outcomes via a retrospective review of 182 adult LDLT cases including 25 ABO-I LDLTs from January 2011 to December 2014. Propensity scoring was used to compare the groups. The desensitization protocol included plasma exchange, rituximab, and intravenous immunoglobulin without local infusion therapy. The triple immunosuppression protocol consisted of tacrolimus and steroids with mycophenolate mofetil; a splenectomy was not routinely performed. The median age of recipients was 51 years (range, 35-66 years), and the median mean Model for End-Stage Liver Disease (MELD) score was 15 (range, 7-37). The initial ranges of isoagglutinin IgM and IgG titers were 1:1 to 1:256 and 1:4 to 1:2048, respectively. There were no significant differences in patient demographics or perioperative variables between the groups. Although significant rebound elevation in anti-ABO antibody during the postoperative period was observed in 3 cases, neither C4d staining nor clinical signs of antibody-mediated rejection was apparent in these cases. No diffuse intrahepatic biliary stricture was encountered in any ABO-I LDLT patient within a mean follow-up of 22.6 ± 17.2 months. Moreover, no significant difference in overall or graft survival was observed between the groups. ABO-I LDLT can be performed safely under this new simplified protocol and may be proposed when ABO-compatible donors are unavailable.

Total extract of Korean red ginseng facilitates human bone marrow hematopoietic colony formation in vitro.

Background The number of CD34+ cells in a peripheral blood stem cell collection is the key factor in predicting successful treatment of hematologic malignancies. Korean Red Ginseng (KRG) (Panax ginseng C.A. Meyer) is the most popular medicinal herb in Korea. The objective of this study was to determine the effect of KRG on hematopoietic colony formation. Methods Bone marrow (BM) samples were obtained from 8 human donors after acquiring informed consent. BM mononuclear cells (MNCs) were isolated, and CD34+ cells were sorted using magnetic beads. The sorted CD34+ cells were incubated with or without total extract of KRG (50 µg/mL, 100 µg/mL) or Ginsenoside Rg1 (100 µg/mL), and the hematopoietic colony assay was performed using methylcellulose semisolid medium. The CD34+ cell counts were measured by a single platform assay using flow cytometry. Results The numbers of human BM-MNCs and CD34+ cells obtained after purification were variable among donors (5.6×107 and 1.3-48×107 and 8.9×104 and 1.8-80×104, respectively). The cells expanded 1,944 times after incubation for 12 d. Total extract of KRG added to the hematopoietic stem cell (HSC)-specific medium increased CD34+ cell counts 3.6 times compared to 2.6 times when using HSC medium alone. Total numbers of hematopoietic colonies in KRG medium were more than those observed in conventional medium, especially that of erythroid colonies such as burst forming unit-erythroid. Conclusion Total extract of KRG facilitated CD34+ cell expansion and hematopoietic colony formation, especially of the erythroid lineage.

Changes of Peripheral Blood Lymphocyte Subtypes in Patients with End Stage Cancer Administered Localized Radiotherapy and Bojungikki-Tang

Localized radiotherapy (RT) can cause immune dysfunction. Bojungikki-tang is known to restore immune function. We investigated the absolute counts and percentages of peripheral blood (PB) lymphocyte subtypes in end stage cancer patients before and after RT and after oral administration of Bojungikki-tang water extract (BJITE) and to evaluate the changes mediated by RT and BJITE. Absolute counts and percentages of lymphocyte and lymphocyte subsets were determined in whole blood using the TetraONE System (Beckman Coulter, USA). Flow cytometry results were compared before and after RT and after administration of BJITE. Absolute numbers of CD3+, CD4+, and CD8+ T cells and CD19+ B cells decreased significantly after RT (P < 0.05). Absolute numbers of CD3-CD56+ cells did not change in both groups. No significant differences were observed in the absolute counts of lymphocyte subtypes before and after administration of BJITE or vitamin group. When BJITE group was compared with vitamin group, absolute numbers of CD19+ B cells increased. RT-induced decrease in T cells and B cells in PB suggests that immune deterioration occurs after RT. Administration of BJITE might be effective in the restoration of number of B cells.

Prevalence and Clinical Characteristics of Mupirocin-Resistant Staphylococcus aureus

Background: Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a known risk factor for nosocomialtransmission and infection. In an effort to mitigate this problem, topical mupirocin has been widely used for clearing nasal carriage of MRSA. However, mupirocin resistance has become a worldwide concern due to increased use of the antibiotic. The aims of this study were to evaluate the clinical characteristics and prevalence of mupirocin resistance among clinical isolates of staphylococci and to investigate antimicrobial susceptibility. Methods: A total of 175 S. aureus specimens recovered over a 4-month period from various body sites were tested for resistance to mupirocin and other antibiotics using the Vitek2 automated system. The presence of the mupA gene was assessed in isolates exhibiting resistance to mupirocin and in other selected organisms. The clinical characteristics of the isolates were also reviewed. Results: Of the 175 S. aureus isolates, 9.1% (16/175) were resistant to mupirocin, with 1.7% (3/175) having high-level resistance (HR) and 7.4% (13/175) having low-level resistance (LR). Patients with HR-mupirocinresistant S. aureus had a longer duration of hospitalization (P=0.026). Of the 13 LR-mupirocin-resistant S. aureus strains, 11 had identical antibiogram patterns. The mupA gene was detected only among HR isolates. Conclusion: The rate of mupirocin resistance in the S. aureus isolates was high. The spread of mupirocinresistant S. aureus may be due to nosocomial infection. (Korean J Clin Microbiol 2011;14:18-23)

Effects of one directional pneumatic tube system on routine hematology and chemistry parameters; A validation study at a tertiary care hospital

Background The validation of sample stability through pneumatic tube system (PTS) is essential. The objective of this study was to evaluate the effects of PTS transportation on laboratory results. Methods Paired EDTA and SST blood samples were collected from 56 randomly selected patients. Laboratory parameters were compared between PTS group and hand-delivered group. Results No statistical differences were observed for complete blood counts, white blood cell differential parameters, erythrocyte sedimentation rate and most chemistry parameters between PTS and hand-delivered transport procedures. Mean platelet volume results obtained from samples transported through PTS were lower than that obtained from samples transported through hand-delivered method (P = 0.001). The results of aspartate aminotransferase (P = 0.000), lactate dehydrogenase (P = 0.000), and hemolysis index (P = 0.000) from PTS group were higher than that from hand-delivered group. Conclusions All laboratories should validate the stability of the results from samples according to transportation method.

Inhibition of P‐glycoprotein facilitated glycosaminoglycan accumulation during chondrogenesis of human bone marrow mesenchymal stem cells

Aim:  P‐glycoprotein (P‐gp) is an adenosine‐5‐triphosphate Binding Cassettes B 1 (ABCB1) transporter that exports various substrates on cellular membrane. Surface expression of P‐gp was decreased during chondrogenesis of human bone marrow mesenchymal stem cells (BM‐MSCs). We examined the role of P‐gp in extracellular matrix deposition during chondrogenesis of human BM‐MSCs.

Analysis of Turnaround Time for Intraoperative Red Blood Cell Issues: A Single-Center Study

Abstract Background When unpredicted surgical blood loss occurs, it is essential that blood arrive from the blood bank in a timely manner. Objective To evaluate the turnaround time (TAT) for red blood cells (RBCs) from the blood bank to the operating suite. Cases with delayed TATs were further analyzed to determine potential causes for the delays. Methods During a 6-month period, intraoperative RBC requests were included among the blood component request lists at a single tertiary care hospital. Results A total of 387 RBC-product requests were received from the operating room, of which 220 (56.8%) cases were intraoperative requests. The overall mean (SD) TAT was 19.4 (9.8) minutes. Mean (SD) preparation-to-issuance time (14.9 [7.8] minutes) contributed more to the overall TAT than did mean (SD) request-to-preparation time (4.5 [7.4] minutes). The 31 cases (14.1%) exceeded the internally mandated TAT threshold (> 30 minutes). Prolonged compatibility testing and delayed courier arrival contributed to TAT delay. Conclusions TAT standards for issuing RBCs from the blood bank to the operating suite should be established and carefully monitored for quality improvement of transfusion services.