In the personalized medicine era, utilizing paraffin blocks in pathology archives for investigating human diseases has come into the limelight.This archived material with clinical data will reduce the research time and could prevent new patient recruitment to obtain tissue for research.However, the clause indicating the necessity of consent from human material providers in the Korean Bioethics and Safety Act has made the Institutional Review Board (IRB) deny permission to use paraffin blocks for research without consent, and alternatively to get the same before starting an experiment.Written consent may be waived off in studies using paraffin blocks with anonymous status or conditions not linked to personal information by applying the paragraph 3, article 16 of the current Bioethics and Safety Act.Also, the IRB should recommend researchers to preserve the blocks as medical records of patients in long-term archives.
Objective: The left ventricular (LV) geometry is well-known prognosticators in various populations. However, there are no data on their role in ischemic stroke patients. We sought to investigate the prognostic significance of LV geometry in ischemic stroke survivors, and the LV geometry-specific differences in blood pressure-mortality relationship. Design and Method: We prospectively recruited 2,328 consecutive patients admitted with acute ischemic stroke to our institute between 2002 and 2010. Of these, 2,069 patients were analyzed, in whom echocardiographic data were available to assess LV geometry. Results: All-cause mortality was significantly greater in concentric hypertrophy (adjusted hazard ratio [HR], 1.451; 95% confidence interval [CI], 1.075 to 1.960) and concentric remodelling (HR, 1.581; 95% CI, 1.147 to 2.179), but marginally higher in eccentric hypertrophy (HR, 1.354; 95% CI, 0.974 to 1.883) than normal geometry in multivariate analyses. Relative wall thickness (RWT) and LV mass index (LVMi) were significantly or marginally associated with all-cause mortality (HR, 1.165, per 0.1U increase in RWT; 95% CI, 1.033 to 1.314 and HR, 1.004, per 1 g/m2 increase in LVMi; 95% CI, 1.000 to 1.007, respectively). Similar results were observed with vascular mortality. In multivariable fractional polynomials, patients with altered LV geometry showed U-curve relationships between acute-phase systolic blood pressure and all-cause or vascular mortality with highest risk in lower extremes, whereas those with normal geometry did not. Conclusions: Echocardiographic assessment for LV geometry provided independent prognostic information in ischemic stroke patients. The U-shaped relation of mortality with blood pressure was found in patients with abnormal LV geometry.Figure
Purpose: Radical gastrectomy and lymph node dissection is the treatment of choice for gastric cancer but the efficacy of surgical treatment of recurrent gastric cancer has been debated. We evaluated the efficacy of surgical treatment for recurrent gastric cancer. Methods: We collected the data on 108 recurrent gastric cancer patients who underwent radical gastrectomy and lymph node dissection for gastric cancer and analyzed the clinicopathologic data, the patterns of recurrence of gastric cancer, and the strategies of treatment for recurrent gastric cancer. Results: The patterns of recurrence were 32 locoregional, 26 hematogenous, 24 peritoneal, and 26 mixed recurrences. The strategies of treatment for recurrent gastric cancer were the combination of surgical treatment and chemotherapy in 31 cases (28.7%), chemotherapy alone in 49 cases (45.4%), and conservative treatment in 28 cases (25.9%). The morbidity and mortality in reoperation group were 35.5% and 9.7%, respectively. The mean survival after recurrence was 25.4, 12.7, and 4.9 months in reoperation group, chemotherapy group and conservative treatment group, respectively. In multivariate analysis, the differentiation of primary tumor, patterns of recurrence, and the strategies of treatment for recurrent gastric cancer were related with survival after recurrence of gastric cancer. Conclusion: Our data suggested that the more aggressive and intensive treatment such as surgical treatment could improve the survival rate for recurrent gastric cancer. Therefore, if the patients’ conditions are tolerable and there is resectability, surgical treatment may be an applicable strategy for recurrent gastric cancer in terms of long-term survival.
Various coronavirus disease 2019 (COVID-19) vaccines are being developed, which show practical preventive effects. Here, we report a 51-year-old healthy man with nephrotic syndrome secondary to minimal change disease (MCD) after Ad26.COV.2 (Janssen) vaccination. He had no comorbid disease and received Ad26.COV.2 on April 13, 2021. Seven days after vaccination, he developed edema and foamy urine. Edema rapidly aggravated with decreased urine volume. He was admitted to the hospital 28 days after vaccination, and his body weight increased by 21 kg after vaccination. His serum creatinine level was 1.54 mg/dL, and 24-h urinary protein excretion was 8.6 g/day. Kidney biopsy revealed no abnormality in the glomeruli and interstitium of the cortex and medulla under the light microscope. Electron microscopy revealed diffuse effacement of the podocyte foot processes, thus, he was diagnosed with MCD. High-dose steroid therapy was applied, and his kidney function improved three days after steroid therapy. Three weeks after steroid use, his serum creatinine decreased to 0.95 mg/dL, and spot urine protein-to-creatine decreased to 0.2 g/g. This case highlights the risk of new-onset nephrotic syndrome secondary to MCD after vectored COVID-19 vaccination. Although the pathogenesis is uncertain, clinicians need to be careful about adverse renal effects of COVID-19 vaccines.
Abstract Anti‐phospholipid syndrome (APS) nephropathy is an autoimmune disease that is sometimes accompanied by systemic lupus erythematosus (SLE). Here, we report the use of rituximab to treat a case of APS nephropathy in a SLE patient with recurrent vascular thrombosis. A 52‐year‐old woman, who had been diagnosed with SLE 11 years earlier, was referred to a nephrology clinic for evaluation of azotaemia and proteinuria. She had experienced spontaneous abortion at 35 years of age. The patient had been diagnosed with right popliteal thrombosis at 39 years of age, and with left pulmonary artery thrombosis and SLE at 41 years of age. Before admission, she was undergoing anticoagulant and immunosuppressive therapies, with follow‐up in the rheumatology clinic. At her last outpatient clinic visit before admission, she exhibited mild bilateral lower‐limb pitting oedema, impaired renal function and proteinuria. Renal biopsy revealed arteriolar wall thickening, with thrombi in the capillary lumina and marked inflammatory cell infiltration in the interstitium. The patient was treated with warfarin and high‐dose corticosteroids. Intravenous rituximab (500 mg) was also administered twice at a 4‐week interval. Her renal function did not worsen any further, and her proteinuria decreased. Here we report the successful use of rituximab to treat APS nephropathy in a patient with SLE, who had progressive renal insufficiency.
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