Sungwook Song

Characteristics of clinical isolates of Acinetobacter genomospecies 10 carrying two different metallo-β-lactamases

Acquired metallo-beta-lactamase (MBL) production is an important mechanism of carbapenem resistance. To our knowledge, carriage of two different MBLs has not been described previously in Acinetobacter spp. We present the characteristics of five Acinetobacter isolates carrying two different MBL genes. The species of all five Acinetobacter isolates with two different MBL genes were Acinetobacter genomospecies 10, and bla(IMP-1), bla(VIM-2) and bla(SIM-1) may coexist in this species. Minimum inhibitory concentrations (MICs) of imipenem for all five isolates with two different MBLs were >or=32 microg/mL, whilst those for two segregants that lost both MBLs were 0.5 microg/mL. The presence of MBL gene-carrying integrons with identical structures suggested the easily transferable nature of the elements, whilst instability of the MBL genes indicated potentially erroneous phenotypic and genetic characterisation.

Photothermal spectral-domain optical coherence reflectometry for direct measurement of hemoglobin concentration of erythrocytes

A novel optical detection method for hemoglobin concentration is described. The hemoglobin molecules consisting mainly of iron generate heat upon their absorption of light energy at 532 nm, which subsequently changes the refractive index of the blood. We exploit this photothermal effect to determine the hemoglobin concentration of erythrocytes without any preprocessing of blood. Highly sensitive measurement of refractive index alteration of blood samples is enabled by a spectral-domain low coherence reflectometric sensor with subnanometer-level optical path-length sensitivity. The performance and validity of the sensor are presented by comparing the measured results against the reference data acquired from an automatic hematology analyzer.

A tandem triplication, trp(1)(q21q32), in a patient with follicular lymphoma: a case study and review of the literature.

A 1q triplication is a rare karyotypic event in hematologic malignancies, with 26 cases of 1q triplication reported in the literature. Although 1q duplication or triplication is present with a high incidence in Burkitt lymphoma and Fanconi anemia, there have been no detailed reports of an association between non-Burkitt type lymphomas and 1q triplication. Presented here is the case of a 69-year-old man with follicular lymphoma (FL) and 1q triplication, with a review of the pertinent literature. The patient was diagnosed with FL with bone marrow involvement; his bone marrow chromosome study revealed 50,XY,trp(1)(q21q32),+3,+add(3)(q21),+7,+9,add(13)(p11.2)[11]/51 approximately 52,idem,+19,+22[8]/46,XY[3]. Review of the Mitelman Database of Chromosome Aberrations in Cancer revealed 7 previous cases of non-Burkitt type lymphoma (including FL) with 1q triplication. On the basis of these eight cases, we conclude that 1q triplication represents a rare secondary genetic event with prognostic significance in patients with FL or other non-Burkitt types of lymphoma. Further studies are needed to investigate these rare 1q triplication in hematologic malignancies.

Concomitant t(3;3)(q21;q26), trisomy 19, and E255V mutation associated with imatinib mesylate resistance in chronic myelogenous leukemia

Four broad mechanisms of imatinib mesylate (IM) resistance in chronic myelogenous leukemia (CML) have been characterized: decreased intracellular drug levels, increased expression of BCR/ABL kinase from genomic amplification, secondary clonal change (non-BCR/ABL dependent mechanism), and tyrosine kinase domain mutations [1]. Representative secondary or additional chromosomal abnormalities in CML include þder(22), þ8, i(17)(q10), and þ19, among others. Although it is less frequent, t(3;3)(q21;q26) was also reported as a rare secondary karyotypic event in CML patients. Review of the Mitelman database revealed only 3 AML cases and 13 CML cases with simultaneous t(3;3) and t(9;22) abnormalities [2]. These patients may acquire t(3;3) in accelerating or blast phase, and such a finding is usually considered as a sign of aggressive phase or drug resistance. In addition, O60 different point mutations that code for distinct single amino acid substitutions in the BCR/ABL kinase domain have been reported in relapsed CML patients resistant to IM treatment [3]. We are not aware of reports dealing with concomitant t(3;3)(q21;q26) and tyrosine kinase domain mutation in CML. Here, we describe a novel case of CML with b2a2 fusion transcript accompanying t(3;3), trisomy 19, and E255V mutation that showed an aggressive clinical course. A 49-year-old Korean woman had a history of CML with b2a2 fusion transcript dating from June 2004. An abnormality was identified in her follow-up quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) analysis for BCR/ABL rearrangement. After the original CML diagnosis (June 2004), she was treated with IM for 4 years, in complete remission status. In June 2008, complete blood examination showed a hemoglobin level of 12.0 g/dL, a platelet count of 749,000/mL, and a white blood cell count of 20,700/mL. At this time, quantitative RT-PCR assay with whole blood showed a high level of BCR/ABL ratio (2.34). Three months later, marked leukocytosis (white blood cell count of 211,200/mL with 5% blasts, 25% promyelocytes, 29% myelocytes, 7% metamyelocytes, 16% band forms, 16% segmental neutrophils, and 2% monocytes) led us to perform a bone marrow examination. Although her bone marrow biopsy showed hypercellularity with increased myeloid to erythroid ratio

Biphenotypic acute leukemia with b2a2 fusion transcript and trisomy 21

Fig. 1. G-banded karyogram of bone marrow cells: 47,XX,t(9;22) Biphenotypic acute leukemia (BAL) is a rare leukemia, which is identified in 5-10 % of acute leukemia (AL) cases. BAL has been described in the literature as mixed lineage or hybrid AL, myeloid antigen-positive acute lymphoblastic leukemia (ALL), and lymphoid antigen-positive acute myeloid leukemia (AML) [1,2]. The European Group for Immunological Classification of AL (EGIL) has proposed guidelines for scoring lineage-specific antigens commonly used to assign cell lineage [3]. To our knowledge, there is no single chromosomal abnormality which is uniquely associated with BAL. However, several reports revealed that there was a high incidence of the Philadelphia chromosome, t(9;22), in BAL cases [1,4e6], although most of the reported cases were associated with minor BCR/ABL1 rearrangement. To our knowledge, only 2 cases of b2a2 and one case of b3a2 have been documented in BAL [1,7]. In this report, we describe a rare case of BAL with b2a2 fusion transcript accompanying trisomy 21 showing characteristic laboratory findings and clinical features. A 68-year old female was brought to Severance Hospital of Yonsei University with general weakness and poor oral intake. An initial complete blood count (CBC) showed a hemoglobin (Hb) level of 9.4 g/dL, a platelet count of 182,000/mL, and a WBC count of 311,700/mL with 13% segmental neutrophils, 7% lymphocytes, 1% monocytes, 3% atypical lymphocytes, 4% eosinophils, 1% band forms, 7% myelocytes, 2% promyelocytes, and 62% immature cells. Bone marrow aspiration showed a hypercellular marrow packed with leukemic cells, and biopsy confirmed packed marrow showing diffuse proliferation of immature blastic cells. Flow cytometry analysis showed the blasts to be positive for CD10 (43.7%), CD13 (86.1%), CD19 (67.4%), CD33 (74.7%), CD45 (80.2%), CD79a (74.4%), and MPO, and negative for CD3 (2.9%), CD7 (0.2%), CD14 (5.2%), CD20 (1%), cCD22 (0.8%), CD117 (0.4%), and TdT. Chromosome study showed a 47,XX,t(9;22)(q34;q11.2), þ21 chromosome complement in all 20 metaphase cells analyzed (Fig. 1). Multiplex reverse transcriptasepolymerase chain reaction (RT-PCR) assay was performed with HemaVision kit (Bio-Rad Laboratories, Hercules, CA), which is designed to detect 28 kinds of fusion transcripts. The result of gene rearrangement test was consistent with the chromosome study showing b2a2 fusion transcript (Fig. 2). The FISH analysis of BCR/ABL1 also

Association between acute promyelocytic leukemia and ring chromosome 6

After the first report of a ring chromosome in a case of human leukemia by Sandberg et al., ring chromosomes have been infrequently (!10%) detected in hematopoietic neoplasias [1,2]. In most cases, however, ring chromosomes were part of a more or less complex karyotype associated with a poor prognosis [2]. As far as we know, there was no detailed, confirmatory report on an association between a certain leukemia subtype and a specific ring chromosome. Here, we describe a rare, recurrent case of acute promyelocytic leukemia (APL) with simultaneous t(15;17)(q22;q12) and ring chromosome 6 in addition to a relevant literature review. A 47-year-old Korean female with mild fever, myalgia, easy bruising, and toothache was admitted to Severance Hospital of Yonsei University. Initial complete blood count showed a hemoglobin level of 9.3 g/dL and a platelet count of 36,000/mL with a white blood cell count of 10,890/mL

Use of EDTA-plasma gel-separating tubes for measurement of indocyanine green

Preoperative assessment of liver function is extremely important for decreasing mortality and morbidity following liver resection in cirrhotic and non-cirrhotic patients (1). Indocyanine green (ICG) retention at 15 min (ICG R15) has been used for many years to evaluate hepatic function reserve, to determine the limits of hepatectomy, and to monitor the functional capacity following hepatic resection (2–4). After a bolus injection of ICG, the dye is removed exclusively by the liver. Since ICG is removed exclusively by the liver and has a relatively high intrinsic clearance, ICG R15 indicates hepatic perfusion. The ICG concentration is usually measured using a spectrophotometer at a wavelength of 805 nm. At our hospital, ICG concentrations are measured manually using EDTA-plasma on a DU-650 spectrophotometer (Beckman Instruments, Inc., Miami, FL, USA). Depending upon the current trends in the laboratory automation, EDTA-plasma separating tubes with gel (EDTA-PST) are required to perform the ICG test using an automated analyzer, such as the Hitachi 7180 (Hitachi, Tokyo, Japan). EDTA-PST, originally used for testing plasma in molecular diagnosis and viral load detection, can be used directly on automated analyzers following centrifugation. However, there have been reports that the inert polymer gel within the serum separating tube (SST) can cause interferences on measurement of several drugs, hormones, and other proteins (5–8). In this study, we evaluated the usefulness of EDTA-PST for the ICG test. K2E K2EDTA tubes (Greiner Bio-One, Kremsmünster, Austria) were used to obtain EDTA-plasma and K2E K2EDTA Sep (Greiner Bio-One, Kremsmünster, Austria) for EDTA-PST. A total of 51 subjects (female, ns18; male, ns33) who were undergoing preopera-