Sollip Kim

Molecular Epidemiological Investigation of a Nosocomial Outbreak of Human Metapneumovirus Infection in a Pediatric Hemato-Oncology Patient Population

ABSTRACT We report the first nosocomial outbreak of human metapneumovirus (hMPV) infection in a pediatric patient population. Among 15 pediatric hMPV infections from March to May 2007, there was a nosocomial outbreak involving two patients sharing a room in a hemato-oncology ward with a patient with a community-acquired case of hMPV infection. The estimated incubation period was 7 to 9 days for a symptomatic nosocomial case. Sequencing of fusion genes of 15 isolates revealed two clusters belonging to subgroup A2 and one cluster belonging to subgroup B2. Three isolates from the outbreak had sequences identical to those of samples in the A2 cluster. There was also a separate nosocomial case represented by the B2 cluster.

Serum BDNF Levels in Relation to Illness Severity, Suicide Attempts, and Central Serotonin Activity in Patients with Major Depressive Disorder: A Pilot Study

The aim of this study was to test the hypothesis that serum levels of brain-derived neurotrophic factor (BDNF) are correlated with the loudness dependence of auditory evoked potentials (LDAEP). The question of whether there is a difference in BDNF levels between depressive patients according to their illness severity, history of suicide attempts, and central serotonin activity was also addressed. A sample of 51 patients who met the criteria for major depressive disorder following diagnosis using axis I of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders – text revision comprised the study subjects. The patients were stratified into two subgroups based on their illness severity, history of suicide attempts, and their LDAEP values. The LDAEP was evaluated by measuring the auditory event-related potentials, and serum BDNF was measured using blood sampling before beginning medication with serotonergic agents. There was no difference in serum BDNF levels between the two patient subgroups. The subgroup with moderate-to-severe depression (n = 16) was reanalyzed after stratifying it into two subgroups according to LDAEP and BDNF values (dichotomized at the medians into low and high). The high-LDAEP subgroup had higher serum BDNF levels and total Barratt Impulsiveness Scale score than the low-LDAEP subgroup (p = 0.03 and 0.036, respectively). Serum BDNF levels were positively correlated with LDAEP and total Beck Hopelessness Scale (BHS) score (r = 0.56, p = 0.025, and r = 0.59, p = 0.016, respectively). The high-BDNF subgroup had a higher LDAEP and total BHS score than the low-BDNF subgroup (p = 0.046 and p = 0.011, respectively). This is the first study to demonstrate a relationship between the BDNF level and LDAEP in Asian depressive patients. Intriguingly, the high-BDNF subgroup (divided according to illness severity) exhibited a more severe psychopathology on some psychometric rating scales, a finding that conflicts with previous results.

Four-dimensional ultrasound guidance of prenatal invasive procedures

Technological advances in ultrasonography have revolutionized prenatal diagnosis and treatment. Here we evaluate the effectiveness of using four‐dimensional (4D) ultrasonography to guide prenatal invasive procedures.

Evaluation of the MassTrak Immunosuppressant XE Kit for the determination of everolimus and cyclosporin A in human whole blood employing isotopically labeled internal standards.

Abstract Background: Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is widely used for therapeutic drug monitoring of immunosuppressants given to transplant recipients. This study evaluated the performance of the newly introduced MassTrak Immunosuppressant XE Kit (Waters Corporation; “the Kit”) in the determination of everolimus and cyclosporin A (CsA) using LC-MS/MS. Methods: The linearity, precision, detection limit, carryover and matrix effect of the Kit and comparison of the in-house method and Kit procedure were evaluated according to Clinical and Laboratory Standards Institute guidelines. Results: The Kit afforded good linearity in the measurement of everolimus from 2 to 26 ng/mL (R2=0.996) and of CsA from 42.6 to 1407 ng/mL (R2=0.995). The between- and within-run assay coefficients of variation were 2.3%–8.0% for everolimus and 1.1%–3.1% for CsA. The lower limit of quantitation of everolimus and CsA were 1.1–4.1 ng/mL, respectively. A comparison of CsA values obtained using in-house reagents indicated good correlation with Kit results (R=0.9909). The average matrix effect ranged from 15%–39% for everolimus and 3%–10% for CsA, and ion enhancement was mostly observed for the matrix effect. The effect on analyte/internal standard ratios ranged from 1%–8% for everolimus and 1%–16% for CsA. Conclusions: The Kit employing isotopically labeled internal standards provides reliable measurements of immunosuppressant levels over a broad range of concentrations.

Is plasma neutrophil gelatinase-associated lipocalin a predictive biomarker for acute kidney injury in sepsis patients? A systematic review and meta-analysis.

PURPOSE Neutrophil gelatinase-associated lipocalin (NGAL) is a useful biomarker for early diagnosis of acute kidney injury (AKI). However, the diagnostic value of NGAL for predicting AKI in sepsis patients is unclear. METHODS MEDLINE, EMBASE, and Cochrane Library databases were searched to identify research publications. RESULTS Twelve studies from 9 countries including a total of 1582 patients, of whom 315 (19.9%) developed AKI, were included in the study; plasma NGAL levels were significantly higher in adult sepsis patients with AKI than in those without AKI (mean difference, 274.65; 95% confidence interval [CI], 106.16-443.15; I(2) = 94%). Urine NGAL levels were not significantly different. The diagnostic odds ratio of plasma NGAL for predicting AKI in sepsis patients was 6.64 (95% CI, 3.80-11.58). The diagnostic accuracy of plasma NGAL was 0.881 (95% CI, 0.819-0.923) for sensitivity, 0.474 (95% CI, 0.367-0.582) for specificity, 0.216 (95% CI, 0.177-0.261) for positive predictive value and 0.965 (95% CI, 0.945-0.977) for negative predictive value. CONCLUSION Plasma NGAL has a high sensitivity and a high negative predictive value for detection of AKI in adult sepsis patients. However, its low specificity and low positive predictive value could limit its clinical utility. The usefulness of urine NGAL was not revealed in this study.

Basal luteinizing hormone and follicular stimulating hormone: is it sufficient for the diagnosis of precocious puberty in girls?

Purpose A gonadotropin-releasing hormone stimulation test (GnRHST) is the gold standard in diagnosing central precocious puberty (CPP). The aim of this study was to investigate the diagnostic accuracy of basal gonadotropin levels for girls with suspected precocious puberty and to evaluate the factors affecting positive results of the GnRHST. Methods Korean girls with early pubertal development who visited the clinic during 2010-2012 were included. Auxological and biochemical tests were evaluated and a standard GnRHST was performed. A peak luteinizing hormone (LH) level of ≥5 IU/L was considered a positive response during the GnRHST. Results A total of 336 girls were included. The positive responses were observed in 241 girls (71.7%), and negative responses were found in 95 girls (28.3%). In the logistic regression analysis, the coefficient of the basal LH and basal LH/follicular stimulating hormone (FSH) ratio was 4.23 (P<0.001) and 21.28 (P<0.001), respectively. Receiver operating characteristic analysis showed that the basal LH/FSH ratio is a better predictor of the pubertal result after the GnRHST than the basal LH (area under the curve was 0.745 and 0.740, respectively; P=0.027). Among 189 girls with a basal LH of <0.1 IU/L, 105 (55.6%) had positive responses. Conclusion An elevated level of the basal LH and basal LH/FSH ratio was a significant predicting factor of positive responses during the GnRHST. However a GnRHST was still necessary for diagnostic confirmation of CPP because more than half of the girls with a basal LH level below the detection limit revealed to have CPP.

Neutrophil gelatinase-associated lipocalin as an early biomarker of acute kidney injury in liver transplantation

Acute kidney injury (AKI) is a common complication and a significant prognostic factor of long‐term outcome in patients undergoing liver transplantation. We evaluated the utility of urine and plasma neutrophil gelatinase‐associated lipocalin (NGAL) concentrations as biomarkers of AKI during and after liver transplantation.

Glycated albumin may be a possible alternative to hemoglobin A1c in diabetic patients with anemia.

Abstract Background: We assessed whether glycated albumin (GA) is a useful glycemic indicator in diabetic patients with anemia who did not undergo dialysis. Methods: Hemoglobin A1c (HbA1c) and GA were simultaneously measured in 370 diabetic subjects who had not undergone dialysis. The relationship between GA and HbA1c was evaluated in patients with and without anemia. Results: GA-to-HbA1c ratio was significantly higher (3.3±0.7 vs. 2.8±0.5, p<0.001) and the regression slope between GA and HbA1c was steeper in diabetic patients with than in those without anemia (6.2 vs. 4.2, p<0.001). Conclusions: HbA1c was underestimated in diabetic patients with anemia than in those without anemia, with the degree of underestimation increasing as glycemic control became poorer. GA may more accurately assess glycemic control in diabetic patients with anemia than HbA1c.

Quantitative risk estimation for large for gestational age using the area under the 100‐g oral glucose tolerance test curve

We devised a complementary quantitative method for gestational diabetes (GDM) that uses the area under the curve (AUC) of the results of the oral glucose tolerance test (OGTT), and evaluated its efficacy in predicting neonates that would be large for gestational age (LGA). The study subjects were 648 pregnant women. The AUC–OGTT (concentration × time) was calculated from the 100‐g OGTT results. The incidence of LGA according to each range of the AUC–OGTT was estimated and odds ratios were analyzed using multiple logistic regression analysis.The incidence of LGA increased with the AUC–OGTT value and was 0% for AUC<300, 7.8% for 300–400, 14.9% for 400–500, 20.8% for 500–600, and 45.5% for ≥600. The odds ratio of LGA increased by approximately two‐fold with an increase of 100 in the AUC–OGTT. The results indicated that the AUC–OGTT can be used to quantify the risk of LGA in GDM. The AUC–OGTT could complement a diagnosis of GDM using conventional diagnostic criteria. J. Clin. Lab. Anal. 23:231–236, 2009.

Detection of bone marrow metastases of neuroblastoma with immunohistochemical staining of CD56, chromogranin A, and synaptophysin.

Neuroblastoma is one of the most common solid tumors occurring in childhood. Bone marrow evaluation is an important part of clinical staging in neuroblastoma patients. In view of the difficulty of detecting neuroblastoma cells with conventional bone marrow aspirate smears and biopsy (BMB) and specimens in cases in which metastasis is not prominent, we propose the use of immunohistochemistry (IHC) as a potential diagnostic tool. We examined 116 BMB and 115 bone marrow clot (BMC) specimens from 60 newly diagnosed neuroblastoma patients for tumor cells. Neuroendocrine IHC markers, such as CD56, chromogranin A, and synaptophysin were applied to diagnose neuroblastoma. Eighteen out of the 60 patients (25.4%) displayed BM metastasis, as observed with conventional hematoxylin and eosin staining. IHC staining of BMC sections was generally more sensitive than that of BMB sections for tumor cell detection. We detected tumors in 5 and 7 additional hematoxylin and eosin-negative BMB and BMC sections, respectively, using CD56. Overall, CD56 or a combination of CD56 and chromogranin A was effective in detecting neuroblastoma cells. IHC analysis of BMB and BMC sections is warranted as a routine component of the diagnostic work-up of neuroblastoma to overcome discrepancies between routine smears and IHC stains.