Comparison of four hematology analyzers, CELL-DYN Sapphire, ADVIA 120, Coulter LH 750, and Sysmex XE-2100, in terms of clinical usefulness

We evaluated the clinical usefulness (leukocyte distribution classification, morphologic classification, and morphologic flags) of the following four hematology analyzers: CELL-DYN Sapphire (CD-Sapphire) (Abbott Diagnostics, Santa Clara, CA, USA), ADVIA 120 (Bayer Diagnostics, Tarrytown, NY, USA), Beckman Coulter LH 750 (Beckman Coulter, Miami, FL, USA), and Sysmex XE-2100 (TOA Medical Electronics Co., Kobe, Japan). Four hundred thirty samples from patients and 100 samples from healthy individuals were analyzed. For distributional classification, the sensitivity rates of CD-Sapphire, ADVIA 120, LH 750, and XE-2100 were 93.1, 95.9, 94.9, and 94.9%, respectively, and the efficiency rates were 80.7, 81.6, 84.1, and 84.2%, respectively. For morphologic classification, the sensitivity rates of CD-Sapphire, ADVIA 120, LH 750, and XE-2100 were 88.6, 93.2, 77.3, and 94.3%, respectively, and the efficiency rates were 80.9, 73.0, 79.5, and 74.2%, respectively. Comparing the findings in different morphologic flags, XE-2100 showed the highest sensitivity for Blasts flag (90.9%); CD-Sapphire showed the highest sensitivity for Immature granulocytes and/or Left-shift flag (85.5%); ADVIA 120 showed the highest sensitivity for Atypical lymphocytes flag (60.0%); and LH 750 showed the highest sensitivity for Nucleated RBC flag (75.0%). Our results demonstrate that the four analyzers are comparable in overall performance.

MR imaging assessment of the lateral head of the gastrocnemius muscle: prevalence of segmental anomalous origins in children and young adults

BACKGROUND

Variations in the lower extremity musculature have been identified, including an anomalous origin of the medial head of the gastrocnemius muscle. Anomalies of the lateral head of the gastrocnemius muscle (LGN) have been less frequently described, especially in children.

OBJECTIVE

To describe the MR imaging appearance, frequency and clinical symptoms associated with anatomic variations of the LGN in children and young adults.

MATERIALS AND METHODS

A retrospective review of 465 knee MR imaging examinations was performed. The site of origin of the LGN was identified as either normal, lateral segmental anomalous origin (LSAO), or medial accessory anomalous origin (MAAO). The clinical indication for imaging was recorded.

RESULTS

An anatomic variation of the LGN was identified in 16 patients (3.4%). Nine patients had LSAO, and five of these had symptoms referable to or abnormalities of the patella. Seven patients had MAAO, and three of these had chronic nontraumatic knee pain.

CONCLUSION

Anatomic variations of the LGN are not rare in young patients, occurring with a frequency of 3.4% in our series. It is unknown whether these anomalies play a role in the etiology of patellofemoral pain or unexplained joint pain in children.

A critical role for the proapoptotic protein bid in ultraviolet-induced immune suppression and cutaneous apoptosis

Apoptosis plays an important role in eliminating UV-damaged keratinocytes, but its role in UV-induced immune suppression is not clear. Langerhans cells (LCs) may function as inducers of immune suppression. We have shown that LCs derived from mice deficient in the proapoptotic Bid (BH3-interacting death domain protein) gene (Bid KO) resist apoptosis and induce amplified immune responses. In this report, we examined responses in Bid KO mice to UVB exposure. Acute UV exposure led Bid KO mice to develop fewer apoptotic cells and retain a greater fraction of LCs in the epidermal layer of skin in comparison to wild-type mice. Bid KO mice were also markedly resistant to local and systemic UV tolerance induction to hapten sensitization and contact hypersensitivity responses. Elicitation responses and inflammation at skin sensitization sites in UV-treated Bid KO mice were equal to or greater than nonsuppressed control responses. In Bid KO mice, LCs accumulated in lymph nodes to greater numbers, demonstrated longer lifespans, and contained fewer DNA-damaged cells. These studies provide evidence that Bid activation is a critical upstream mediator in UV-induced keratinocyte and LC apoptosis and that its absence abrogates UV-induced immune tolerance.

Phylogenetic analysis of swine influenza viruses recently isolated in Korea

Several influenza A viral subtypes were isolated from pigs during a severe outbreak of respiratory disease in Korea during 2005 and 2006. They included a classical swine H1N1 subtype, two swine-human-avian triple-recombinant H1N2 subtypes, and a swine-human-avian triple-recombinant H3N2 subtype. In the current study, genetic characterization to determine the probable origin of these recent isolates was carried out for the first time. Phylogenetic analysis indicated that all the recent Korean isolates of H1N1, H1N2, and H3N2 influenza are closely related to viruses from the United States. Serologic and genetic analysis indicated that the Korean H1N2 viral subtypes were introduced directly from the United States, and did not arise from recombination between Korean H1N1 and H3N2. We suggest that the H1N1, H1N2, and H3N2 viral subtypes that were isolated from the Korean swine population originated in North America, and that these viruses are currently circulating in the Korean swine population.

Anterior and posterior cruciate ligaments at different patient ages: MR imaging findings

PURPOSE

To retrospectively compile normative data on the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) in children and young adults.

MATERIALS AND METHODS

This HIPAA-compliant study was approved by the institutional review board. The requirement for informed patient consent was waived. Knee MR imaging examinations (n = 324) were performed in 168 female and 156 male patients (age range, 1-20 years) at 1.5 and 3.0 T, and the image findings were retrospectively evaluated by two blinded radiologists separately. One radiologist reviewed all images twice at two sessions, and the other reviewed a random subset of half the images during one session. Discordant assessments were resolved by consensus. The sagittal and coronal ACL-tibial angles, Blumensaat line-ACL angle, angle of inclination of the intercondylar roof, ACL-tibial insertion site, and PCL angle and horizontal component-to-vertical component ratio were measured. The associations between these values and patient age, patient sex, and physeal patency were assessed. Linear and fractional polynomial regression models were used to evaluate the relationships between measurements.

RESULTS

ACL-tibial angles became significantly larger (P < .001) with increasing age during skeletal growth and approached adult values after physeal fusion. The Blumensaat line-ACL angle was constant after age 2 years. The inclination of intercondylar roof angle became significantly smaller (P < .001) with increasing age. The ACL-tibial insertion site was constant at the junction of the anterior and middle thirds of the tibial anteroposterior diameter and was not age dependent. The PCL angle became significantly larger (P < .001) with advancing age and in children who had fused as opposed to open physes. The horizontal component-to-vertical component PCL ratio became significantly smaller with advancing age (P < .001).

CONCLUSION

During growth, angulation of the ACL is age dependent. The angle and morphologic changes of the PCL are age dependent throughout skeletal maturation.

Midlife women's attitudes toward physical activity

OBJECTIVE

To explore attitudes toward physical activity among a multiethnic group of midlife women.

DESIGN

A qualitative cross-sectional study using an online forum. RECRUITMENT SETTINGS: Internet communities/groups for midlife women and for ethnic minorities.

PARTICIPANTS

A multiethnic group of 15 midlife women.

INSTRUMENTS

Ten online forum topics on attitudes toward physical activity and seven on ethnic-specific contexts.

DATA ANALYSIS

Thematic analysis, involving line-by-line coding, categorization, and theme extraction.

RESULTS

Six themes across all ethnic groups emerged from the data analysis process, although there were some ethnic differences in details related to each theme. The themes were (a) gendered experience, (b) physical activity as all body movements, (c) no time for physical activity, (d) environment matters, (e) health concerns made me do it, and (f) need a companion.

CONCLUSIONS

Nurses need to consider and further investigate the influence of women's multiple roles, cultural factors, and environmental factors on physical activity in order to promote physical activity of midlife women.

Age-dependent potassium iodide effect on the thyroid irradiation by 131I and 133I in the nuclear emergency

The initial near-field exposure is primarily through inhalation in a nuclear emergency and the dominant contribution to the effective inhalation dose comes from radioiodine. Thyroid blockade by oral potassium iodide (KI) is efficient and practical for public in the nuclear emergency. Age-dependent radioprotective effect of KI on the thyroid irradiation by (131)I and (133)I has been derived using the simplified compartment model of iodine metabolism and WinSAAM program. Administration of KI within 2 h after (131)I and (133)I intake can block thyroid uptake significantly, yielding protective effect of 78.9% and 74.3%, respectively, for (131)I and (133)I for adults. The mean absorbed doses decrease with age, while protective effects of KI are similar for all age groups.

Conjoined lumbosacral nerve roots compromised by disk herniation: sagittal shoulder sign for the preoperative diagnosis

OBJECTIVE

The objective was to determine the importance of the "sagittal shoulder sign" on magnetic resonance (MR) images for the diagnosis of conjoined lumbosacral nerve roots (CLNR) that are compromised by herniated disks.

MATERIALS AND METHODS

Magnetic resonance images of 11 patients (6 men and 5 women; age range, 25-71 years; average age, 48.7 years) with surgically proven CLNR, which was compromised by herniated disks, were retrospectively evaluated by two musculoskeletal radiologists. MR images were evaluated for the presence or absence of the sagittal shoulder sign-a vertical structure connecting two consecutive nerve roots and overlying disk on the sagittal MR images. The radiologists noted the type of accompanying disk herniation and bony spinal canal changes, as well as other characteristic MR features of CLNR, the common passage of two consecutive nerve roots through the neural foramen on axial MR images.

RESULTS

The sagittal shoulder sign was identified with a mean frequency of 90.9% by the two observers (in 10 of 11 patients). The common passage of two consecutive nerve roots through the neural foramen on axial MR images was identified with a mean frequency of 59.1% (in 7 and 6 out of 11 patients, by observers 1 and 2, respectively). Good interobserver agreement for the sagittal shoulder sign was present (k = 0.621, p < 0.05).

CONCLUSION

Observation of the sagittal shoulder sign may prove helpful for diagnosing CLNR in patients with disk herniation. In particular, this sign appears to be useful when there is no evidence of CLNR on axial MR images.

Prediction of hypothyroidism after hemithyroidectomy: a biochemical and pathological analysis

The possibility of postsurgical hypothyroidism after hemithyroidectomy is no longer a new subject. Although many previous studies have mentioned posthemithyroidectomy hypothyroidism, the incidence and contributing factors for hypothyroidism remain uncertain. We intended to evaluate the incidence and the time of development of hypothyroidism after hemithyroidectomy and to analyze the relationship of posthemithyroidectomy hypothyroidism with preoperative biochemical parameters and postoperative histopathological findings. From February 2001 through December 2004, 287 consecutive cases of hemithyroidectomized patients were retrospectively analyzed; 136 of these patients were included in this study after the exclusion criteria were applied. The relationship between posthemithyroidectomy hypothyroidism and several parameters such as sex, age, preoperative free T4, TSH, microsomal antibody (Ab), thyroglobulin antibody (Ab) levels and lymphocytic infiltration of the resected gland was statistically analyzed. Postoperative hypothyroidism developed in 58 patients (42.6%). In hypothyroid group, 11 patients (19%) showed overt hypothyroidism and 47 patients (81%) showed subclinical hypothyroidism. Preoperative TSH value was significantly higher in the hypothyroid group (2.15+/-1.30 microU/ml) compared to the euthyroid group (1.29+/-0.9 microU/ml). Positive ratio of preoperative microsomal Ab and thyroglobulin Ab were significantly higher in hypothyroid group (38.9 and 41.9%) compared to euthyroid group (3.6 and 19.3%) (P <0.05). In addition, patients with a higher grade of lymphocytic infiltration were found to have a higher probability of developing hypothyroidism. About 85% of postoperative hypothyroidism was detected between 1 and 6 months postoperatively. We might predict the possibility of developing the posthemithyroidectomy hypothyroidism especially in case of preoperatively positive microsomal antibody, thyroglobulin antibody and high-grade lymphocytic infiltration of the resected gland. In addition, our findings support the recommendation for regular serum TSH follow-up at least for 12 months after hemithyroidectomy.

Ultra fast symmetry and SIMD-based projection-backprojection (SSP) algorithm for 3-D PET image reconstruction

Remarkable progress in positron emission tomography (PET) development has occurred in recent years, in hardware, software, and computer implementation of image reconstruction. Recent development in PET scanners such as the high-resolution research tomograph (HRRT) developed by CTI (now Siemens) represents such a case and is capable of greatly enhanced resolution as well as sensitivity. In these PET scanners, the amount of coincidence line data collected contains more than 4.5 x 10(9) coincidence lines of response generated by as many nuclear detectors as 120 000. This formidable amount of data and the reconstruction of this data set pose a real problem in HRRT and have also been of the major bottle neck in further developments of high resolution PET scanners as well as their applications. In these classes of PET scanners, therefore, obtaining one set of reconstructed images often requires many hours of image reconstruction. For example, in HRRT with full data collection in a normal brain scan (using SPAN 3), the image reconstruction time is close to 80 min, making it practically impossible to attempt any list-mode-based dynamic imaging since the image reconstruction time would take many days (as much as 43 h or more for 32-frame dynamic image reconstruction). To remedy this data-handling problem in image reconstruction, we developed a new algorithm based on the symmetry properties of the projection and backprojection processes, especially in the 3-D OSEM algorithm where multiples of projection and back-projection are required. In addition, the single-instruction multiple-data (SIMD) technique also allowed us to successfully incorporate the symmetry properties mentioned above, thereby effectively reducing the total image reconstruction time to a few minutes. We refer to this technique as the symmetry and SIMD-based projection-backprojection (SSP) technique or algorithm and the details of the technique will be discussed and an example of the application of the technique to the HRRT's OSEM algorithm will be presented as a demonstration.

Mature cataract and lens-induced glaucoma associated with an asymptomatic intralenticular foreign body

We report a case of mature cataract and lens-induced glaucoma associated with an asymptomatic intralenticular foreign body. At initial presentation, the patient had no definite history of ocular trauma. During cataract surgery, a metallic intralenticular foreign body was expressed with hydrodissection and easily removed with intraocular forceps. Postoperative visual acuity, ocular status, and electroretinographic findings indicated that the crystalline lens served as a natural barrier to irreversible intraocular toxicity.

CD8+ Tc1 and TIL-17 cells mediate allergic contact hypersensitivity by different mechanisms (37.18)

Allergen induced contact hypersensitivity(CHS) in the skin has been considered to be mediated by CD4+ Th1 and CD8+ Tc1 cells that produce IFN-γ. Our recent studies have demonstrated that CD8+ IL-17 producing T cells (TIL-17) play important roles in the elicitation of CHS. Allergen sensitization induces the development of CD8+ Tc1 and TIL-17 cells that are distinct T cell subpopulations. Here we demonstrate that both CD8+ Tc1 and TIL-17 cells play a role in the elicitation of CHS. However, they mediate inflammatory reactions in the skin by different mechanisms. CHS was reduced but not abolished in mice that were defect in the receptor for IFN-γ (IFN-γR−/−) or IL-17 (IL-17R−/−) compared to wild type controls. Similar results were observed in the adoptive transfer of CHS in the gene knockout mice that were transferred with allergen primed wild type CD8+ T cells. However, neutralization of IL-17 in IFN-γR−/− or IFN-γ in IL-17R−/− recipient mice abrogated the response. It implicates that both IFN-γ and IL-17 signals are involved in the elicitation of CHS and are required for optimal responses. Immunohistochemical analysis indicated that the infiltration of Gr-1+ granulocytes and CD11b+ macrophages in the allergen challenged skin of IL-17R−/− mice was significantly reduced whereas it was slightly affected in IFN-γR−/− mice. Further analysis using real time RT-PCR showed different patterns of chemokines and inflammatory cytokines in the allergen challenged skin of IFN-γR−/− or IL-17R−/− mice. These data indicate that both CD8+ Tc1 and TIL-17 cells take part in the elicitation of CHS and that specific mechanisms orchestrate Tc1 and TIL-17 mediated inflammatory reactions in the skin. The result of current studies may provide new insights into therapeutic strategies for T cell mediated inflammatory disorders.

Recent progress of moving-actuator type mechanical circulatory support systems: AnyHeart and T-PLS

The mechanical circulatory support system using moving-actuator mechanisms were developed by Seoul National University and Korea University. AnyHeart is a fully implanted pulsatile bi-ventricular assist device, and T-PLS is a pulsatile flow versatile extracorporeal life support system. Through lots of in-vitro and in-vivo experiments, the developed mechanical systems are faced to produce on commercial scale. This paper describes the recent progress of two mechanical circulatory support systems, AnyHeart and T-PLS.

CD8+ IL-17-producing T cells are important in effector functions for the elicitation of contact hypersensitivity responses

Allergen-induced contact hypersensitivity (CHS) is a T cell-mediated delayed-type immune response which has been considered to be primarily mediated by CD8+ T cytotoxic type I (Tc1) cells. IFN-gamma, the prototype Tc1 (Th1) cytokine, has been implicated as the primary inflammatory cytokine for CHS. In this study, we demonstrate that neutralization of IL-17 rather than IFN-gamma suppresses the elicitation of CHS. The suppression does not result from inhibition of the proliferation of allergen-activated T cells. Allergen sensitization induces the development of distinct CD8+ T cell subpopulations that produce IFN-gamma or IL-17. Although CD8+ IL-17-producing cells are stimulated by IL-23, they are inhibited by IL-12, a prototypical stimulator of IFN-gamma-producing Tc1 cells. This indicates that CD8+ IL-17-producing cells are distinct from Tc1 cells and are important in effector functions at the elicitation of CHS. These studies provide insights into a novel mechanism for CHS.

Vertical profile of algal distribution during aeration prior to intake tower for safe drinking water

Blue-green algae or cyanobacteria comprise a diverse group of organisms, all of which generate potent natural toxins, as well as characteristic odours. In particular, blue-green algae, such as Microcystis and Anabaena, are often detected abundantly in surface water used as a drinking water resource. In order to confirm our ability to provide safe drinking water even during a water bloom, we have conducted an investigation into the vertical distribution of algae during aeration prior to entry into the intake tower at a dam site. Our analysis of the vertical algal distribution during aeration indicated that aeration occurring at the intake tower exerts a significant influence on the safety of the drinking water. It was determined that the discontinuation of aeration and an increase in the depth at which water intake is conducted, constitutes a viable strategy for the maintenance of toxin- and odour-free drinking water, particularly during water bloom events.

Rapid and comprehensive indicator for evaluation of performance of treatment processes and of river waters

Naturally occurring UV active compounds, commonly present in almost all source waters, can be rapidly monitored by their ultraviolet absorbance at 260 nm (E260). Herein, the extent of correlation between the E260 and the removal efficiency of the hazardous contaminants, endocrine disrupters and dioxins, were investigated using various treatment and river source waters. The detection of various types of hazardous contaminants using sophisticated analytical methods, such as high resolution gas chromatography (HRGC)/high resolution mass spectrometry (HRMS) and high performance liquid chromatography (HPLC)/inductively coupled plasma (ICP)/mass spectrometry (MS), as well as various short-term bioassays, can require hours or even days for results to be obtained. The removal of the E260 correlated well with those of individual contaminants, such as endocrine disruptor chemicals and dioxins, with the various treatment processes employed. In the plots of the endocrine disrupters against the DOC/E260, a correlation was found with the endocrine activity of the Korean/Japanese river waters employed in this study.

Development of a Scale to Measure Korean Ego-integrity in Older Adults

PURPOSE

Ego-integrity in older adults is the central concept related to quality of life in later life. Therefore, for effective interventions to enhance the quality of later life, a scale to measure ego-integrity in older adults is necessary. This study was carried out to develop a scale to measure ego-integrity in older adults.

METHODS

This study utilized cronbach's alpha in analyzing the reliability of the collected data and expert group, and factor analysis and item analysis to analyze validity.

RESULTS

Seventeen items were selected from a total of 21 items. Cronbach's alpha coefficient for internal consistency was .88 for the 17 items of ego-integrity in the older adults scale. Three factors evolved by factor analysis, which explained 50.71% of the total variance.

CONCLUSIONS

The scale for measuring ego-integrity in Korean older adults in this study was evaluated as a tool with a high degree of reliability and validity.

Global analysis of the human gastric epithelial transcriptome altered by Helicobacter pylori eradication in vivo

OBJECTIVE

The transcriptional profile of gastric epithelial cell lines cocultured with Helicobacter pylori and the global gene expression of whole gastric mucosa has been described previously. We aimed to overcome limitations of previous studies by determining the effects of H pylori eradication on the transcriptome of purified human gastric epithelium using each patient as their own control.

DESIGN

Laser capture microdissection (LCM) was used to extract mRNA from paraffin-embedded antral epithelium from 10 patients with peptic ulcer disease, before and after H pylori eradication. mRNA was reverse transcribed and applied on to Affymetrix cDNA microarray chips customised for formalin-fixed tissue. Differentially expressed genes were identified and a subset validated by real-time polymerase chain reaction (PCR).

RESULTS

A total of 13 817 transcripts decreased and 9680 increased after H pylori eradication. Applying cut-off criteria (p<0.02, fold-change threshold 2.5) reduced the sample to 98 differentially expressed genes. Genes detected included those previously implicated in H pylori pathophysiology such as interleukin 8, chemokine ligand 3, beta defensin and somatostatin, as well as novel genes such as GDDR (TFIZ1), chemokine receptors 7 and 8, and gastrokine.

CONCLUSIONS

LCM of archival specimens has enabled the identification of gastric epithelial genes whose expression is considerably altered after H pylori eradication. This study has confirmed the presence of genes previously implicated in the pathogenesis of H pylori, as well as highlighted novel candidates for further investigation.

Popliteal artery entrapment syndrome: morphological classification utilizing MR imaging

OBJECTIVE

To retrospectively analyze magnetic resonance (MR) findings in patients with popliteal arterial entrapment syndrome.

MATERIALS AND METHODS

This study was a retrospective MRI and CT scan review of 12 patients with 23 limbs with popliteal artery entrapment syndrome (PAES) treated over a 10-yr period. All 12 patients (23 limbs) were evaluated with MR and CT scan (11 patients - bilateral sides; one patient - unilateral side). All cases were classified as to various types of anomalous relationships between the popliteal artery and the neighboring muscles. The PAES was classified to gastrocnemius medial head and lateral head anomaly. Gastrocnemius medial head anomaly was classified according to the classification made by Whelan and Rich, from type 1 to type 6 [12, 13]. Gastrocnemius lateral head anomaly was defined as popliteal artery entrapment due to medially inserted gastrocnemius lateral head or aberrant accessory head of gastrocnemius lateral head.

RESULTS

The gastrocnemius medial head anomaly was found in 14 limbs (14/23). The classic type 1 was found in none, type 2 in five patients (six limbs), type 3 in four patients (five limbs), type 4 in none, type 5 in one patient (one limb) and type 6 in one patient (two limbs). The uncommon type, i.e. lateral head of gastrocnemius anomaly, was found in five patients (eight limbs).

CONCLUSION

The gastrocnemius medial head anomaly was the cause of PAES, and PAES was classified by medial head anomaly. However the gastrocnemius lateral head anomaly was also the cause of PAES, and most cases of gastrocnemius lateral head anomaliy showed aberrant accessory slip which entrapped the popliteal artery and vein.

Fatty acids, inhibitors for the DNA binding of c-Myc/Max dimer, suppress proliferation and induce apoptosis of differentiated HL-60 human leukemia cell

c-Myc is instrumental in the progression of Burkitt's lymphoma including HL-60 human leukemia cells. We tested fatty acids for their inhibitory effect on the DNA binding of c-Myc/Max dimeric proteins of human origin, prepared as recombinant proteins encompassing DNA binding (basic) and dimerization (HLHZip) domain, and found that those suppress proliferation and induce apoptosis of DMSO-differentiated HL-60 cells. The analyzed IC50 values of myristic acid, stearic acid, gamma-linolenic acid, linoleic acid, linolenic acid and arachidonic acid by EMSA were 97(+/-3), 2.2(+/-1.2), 55(+/-5), 32(+/-2), 62(+/-12), 22(+/-2)microM for DNA binding of recombinant c-Myc/Max, respectively. According to the results shown by XTT assay, their influence on proliferation was quite different from the rank order of IC50. Whereas the degree of influence of the unsaturated fatty acids on the proliferation of DMSO-differentiated HL-60 cells was similar, the influence of saturated fatty acids, stearic acid in particular, was very weak at same concentrations. In addition, we confirmed that these fatty acids have no influence on the expression of c-Myc in DMSO-differentiated HL-60 cells. Our experiments demonstrated that the inhibitors for the DNA binding of c-Myc/Max contribute to the downregulation of Myc-dependent proliferation and to the inducement of apoptosis, and serve as an exploration of potent new inhibitors.