Successful treatment of renal malakoplakia via the reduction of immunosuppression and antimicrobial therapy after kidney transplantation: a case report

Malakoplakia is a rare, granulomatous disease that usually affects immunocompromised individuals and is generally associated with poor graft and patient survival. We present a case of renal malakoplakia after kidney transplantation (KT). A 33-year-old female patient with chronic kidney disease underwent living-donor KT at Severance Hospital. The patient was administered 375 mg/m2 rituximab due to high panel reactive antibodies. Immunosuppression was initiated with 1.5 mg/kg anti-thymocyte globulin and intravenous methylprednisolone and maintained with tacrolimus, oral methylprednisolone, and mycophenolate mofetil (MMF). Six months after KT, the patient was hospitalized for a urinary tract infection with an elevated serum creatinine level of 3.14 mg/dL. Renal biopsy revealed malakoplakia involving the renal parenchyma. Upon this diagnosis, the dose of tacrolimus was reduced and MMF was stopped. Fluoroquinolone was used for 16 days, and the trimethoprim/sulfamethoxazole dose was doubled for 6 days. The patient was hospitalized for 3 weeks and closely observed during outpatient visits. Follow-up ultrasonography revealed mass-like lesions of renal malakoplakia, which disappeared 5 months after diagnosis. The serum creatinine level decreased to 1.29 mg/dL 28 months after diagnosis. Our results suggest that renal malakoplakia can be successfully treated by the reduction of immunosuppression and sustained antimicrobial therapy.ope

Risk Factors for Cytomegalovirus Infection and Its Impact on Survival after Living Donor Liver Transplantation in South Korea: A Nested Case-Control Study

Cytomegalovirus (CMV), a common pathogen, causes infectious complications and affects long-term survival after transplantation. Studies examining living donor liver transplantation (LDLT) are limited. This study analyzed the risk factors for CMV infection and its impact on the survival of LDLT patients. A nested case–control design retrospectively analyzed data from 952 patients who underwent LDLT from 2005–2021. The incidence of CMV infection for the study cohort was 15.2% at 3 months for LDLT patients managed preemptively. Patients with CMV infections were matched with those without the infection at corresponding time points (index postoperative day) in a 1:2 ratio. Graft survival was significantly lower in the CMV infection group than in the control group. CMV infection was an independent risk factor for graft survival in the matched cohort (HR 1.93, p = 0.012). Independent risk factors for CMV infection were female sex (HR 2.4, p = 0.003), pretransplant MELD (HR 1.06, p = 0.004), pretransplant in-hospital stay (HR 1.83, p = 0.030), ABO incompatibility (HR 2.10, p = 0.009), donor macrovesicular steatosis ≥10% (HR 2.01, p = 0.030), and re-operation before index POD (HR 2.51, p = 0.035). CMV infection is an independent survival risk factor, and its risk factors should be included in the surveillance and treatment of CMV infections after LDLT.ope

Risk factors for late-onset Pneumocystis jirovecii pneumonia in liver transplant recipients

Objectives: The risk factors for late-onset Pneumocystis jirovecii pneumonia (PCP) after liver transplantation (LT) have not been well studied. We aimed to analyze the clinical features preceding PCP in LT recipients that would guide individualized prophylaxis. Methods: Among 742 patients who underwent LT and routine PCP prophylaxis from January 2009 through December 2019 at Severance Hospital, 27 patients developed PCP. We conducted a retrospective case-control study matching each patient with four controls and analyzed the risk factors for late-onset PCP. Results: After 6 months, post-transplant PCP cases increased steadily with an overall incidence of 6.36 cases per 1000 patient-year. The PCP-related mortality was 37.0%. In the multivariate analyses, age at LT ≥65 years (odds ratio [OR], 13.305; 95% confidence interval [CI], 2.507-70.618; P = 0.002), cytomegalovirus infection (OR, 5.390; 95% CI, 1.602-18.132; P = 0.006), steroid pulse therapy (OR, 6.564; 95% CI, 1.984-21.719; P = 0.002), hepatocellular carcinoma recurrence (OR, 18.180; 95% CI, 3.420-96.636; P = 0.001), and lymphocytopenia (OR, 3.758; 95% CI, 1.176-12.013; P = 0.026) were independently associated with PCP. Conclusion: Late-onset PCP after routine prophylaxis after LT remains a lethal infection and is associated with age ≥65 years at LT, cytomegalovirus infection, steroid pulse therapy, hepatocellular carcinoma recurrence, and lymphocytopenia. Targeted prophylaxis considering these risk factors could improve the prevention of this potentially lethal complication.ope

고위험 갑상선 암 환자에 있어서 lactate transporter의 역할

Department of Medicine/석사목적: Warburg effect에 따라 종양의 높은 포도당 흡수율을 이용하여 18F-FDG-PET/CT를 사용하여 종양을 발견할 수 있다. 하지만 종양 내 이질성(Heterogeneity) 또는 암 관련 섬유 모세포(CAF) 대사가 포도당 섭취에 영향을 줄 수 있기 때문에 18F-FDG 섭취가 높은 세포가 종양이 아닐 가능성이 있다. 이전까지 알려진 18F-FDG-PET/CT의 예후에 초점을 맞춘 많은 연구에서는 종양 내 이질성이나, 조직 유형의 특이성을 고려하지 않았다. 본 연구에서는 Monocarboxylate transporter 1(MCT 1; SLC16A1)과 Monocarboxylate transporter 4(MCT 4; SLC16A3) 의 발현 패턴에 따라 18F-FDG-PET/CT에서 FDG 섭취가 높은 종양을 소그룹으로 분류 하였다. 이를 통하여 분자 생물학적 및 임상적 특성이 포도당과 젖산 대사에 대한 세포 유형, 종양 유형의 특이성에 따라 차이를 보인다는 것을 관찰했다. 방법: 공개 되어있는 TCGA, NCBI Gene Expression Omnibus (GEO) 프로파일 및 자체 RNA-sequence 데이터로부터 MCT1 및 MCT4의 발현 상태를 평가하였다. MCT4 mRNA 발현의 상태에 따라 THCA에서 hexokinases (HK), glucose transporter (GLUT), lactic dehydrogenase (LDH), pyruvate kinases (PK)와 같은 glycolytic pathway의 핵심 구성 요소의 mRNA 발현 상태 또한 조사 하였다. 인체 갑상선 암 조직을 이용하여 MCT1과 MCT4의 면역 조직 화학 염색(Immunohistochemical; IHC) 염색 분석을 실시하였고, 갑상선 암에서 이들 운반체의 발현 상태에 따라 임상병리인자와 어떤 관계를 보이는지에 대하여 비교 하였다. 결과: THCA, GSE33630 및 자체 RNA-sequence에서 MCT1과 MCT4의 발현률이 정상세포에서 보다 종양세포에서 현격히 증가하였다. 또한 PTC에서 MCT4 mRNA의 발현은 HK3 (r = 0.4911, p <0.0001), GLUT1 (r = 0.2723, p = 0.0002), LDHA (r = 0.4813, p = 0.0001), PKLR r = 0.0797, p = 0.0028), PKM2 (r = 0.4895, p <0.0001)로 양의 상관관계를 보였다. THCA 데이터를 이용한 임상병리인자분석에서 높은 MCT4 발현은 BRAFV600E 돌연변이, 중간 및 높은 재발 위험, 진행된 종양 (T3 및 T4 병기), 림프절 병기 (N1a 및 N1b) 및 BRAFV600E 변이 및 TERT promoter 변이 (p <0.0001)와 상관 관계가 있었다. 이 결과를 뒷받침하는 IHC 염색 결과는, 높은 간질 MCT4 발현률이 진행성 종양 (T3 및 T4 병기), 림프절 병기 (N1a 및 N1b) 및 TNM 병기 (III)와 관련되는 결과를 보였다.(P <0.0001). 그러나, 종양세포에서 MCT4 발현률은 예후에 영향을 미치지 않았다. 결론: 이 연구로 갑상선 암의 진행과정에서 MCT4가 중요한 역할을 함으로 밝혀졌으며, 공격적인 갑상선 암을 선별하는 표지자로서의 역할 및 잠재적 치료 표적으로서 결체조직의 MCT4 사용을 고려할 수 있다.open석

Research on the Welding Information System for a Warship Using Database Technology

Construction method of a warship is quite different from a commercial ship due to the difference of ship materials, ship size and structure, and using purpose. To make the proper decision on the welding method and conditions for a warship construction, understanding of material class, type of materials, welding positions and etc. is required. And sufficient knowledge for structural specifications and manufacturing process at each assembly stage is also the prerequisite for the decision. Welding joints must be designed to satisfy the required strength of the part to be assembled, while the welding materials such as filler metal, flux, and shielding gases should be carefully chosen considering the base metal, welding method and welding conditions. As for the welding procedures, welding condition such as current, volt and welding speed, preheat/postheat processing conditions should be defined to get the sound welding result. Using database technology for the above mentioned process is a good solution because this process requires the vast knowledge and information. The purpose of this study is to develop the welding information system for a warship construction using database technology combined to the object-oriented technology. For this task, the information of warship construction, specially related to welding technology was gathered and reviewed from an object-oriented perspective. And the efficient data model and intuitive graphical user-interface program were developed. The developed information system covers only the midship area of PKG. In the future research, it will be expanded the entire area of PKG.List of tables = Ⅲ List of figures = Ⅳ Abstract = Ⅴ 1. 서론 = 1 2. 데이터베이스 시스템 = 6 2.1 데이터베이스의 정의 = 6 2.2 데이터베이스 관리 시스템 = 8 2.3 응용 프로그램 = 10 3. 군함(PKG)용접 데이터베이스 시스템 = 11 3.1 군함(PKG) 주요 용접의 유형과 종류 = 11 3.1.1 PKG의 주요 용접 기법 = 11 3.1.2 이음형상 = 12 3.1.3 선체재료 및 치수, 구획특성 = 13 3.2 PKG 용접의 표준정보 = 14 3.2.1 용접시방서 = 15 3.2.2 용접 절차 사양서 = 17 3.2.3 용접 정보의 상호관계 = 17 3.3 정보 시스템의 구현 = 20 3.3.1 기본계획의 수립 = 20 3.3.2 데이터베이스의 설계 = 22 3.3.3 개발 데이터베이스 시스템의 검증 및 고찰 = 22 3.3.4 이음부 객체의 생성 = 26 3.3.5 용접설계 및 시공 정보의 지원 = 26 4. 결론 = 31 참고 문헌 = 3

RAPID OPTICAL INSPECTION METHOD OF SEMICONDUCTOR

본 발명은, 반도체의 고속 광학 검사방법에 관한 것으로, 보다 구체적으로, 시편을 여기시키는 단계; 상기 시편에서 발광된 빛을 스캔하여 측정광을 획득하는 단계; 상기 측정광을 분광기로 전달하는 단계; 상기 전달된 측정광을 분광기를 이용하여 선측정하거나 또는 면측정하여 광학정보를 획득하는 단계; 및 상기 광학정보를 CCD(전자결합소자)를 이용하여 CCD 이미지를 획득하여 광학정보를 처리하는 단계; 를 포함하는, 반도체의 고속 광학 검사방법에 관한 것이다. 본 발명은, 기존의 반도체 소자의 광학 검사방법에 비하여, 검사 시간을 대폭줄 일 수 있다