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( Seok Hui Kang ), ( Byung Ha Chung ), ( Sun Ryoung Choi ), ( Ja Young Lee ), ( Hoon Suk Park ), ( In O Sun ), ( Bum Soon Choi ), ( Cheol Whee Park ), ( Yong Soo Kim ), ( Chul Woo Yang ) 대한내과학회 2011 The Korean Journal of Internal Medicine Vol.26 No.1
Background/Aims: Many studies have compared patients with systemic lupus erythematosus (SLE) on renal replacement therapy (RRT) with non-lupus patients. However, few data are available on the long-term outcome of patients with end-stage renal disease (ESRD) secondary to SLE who are managed by different types of RRTs. Methods: We conducted a retrospective multicenter study on 59 patients with ESRD who underwent maintenance RRT between 1990 and 2007 for SLE. Of these patients, 28 underwent hemodialysis (HD), 14 underwent peritoneal dialysis (PD), and 17 patients received kidney transplantation (KT). We analyzed the clinical outcomes in these patients to determine the best treatment modality. Results: The mean follow-up period was 5 ± 3 years in the HD group, 5 ± 3 years in the PD group, and 10 ± 5 years in the KT group (p = 0.005). Disease flare-up was more common in the HD group than in the KT group (p = 0.012). Infection was more common in the PD and HD groups than in the KT group (HD vs. KT, p = 0.027; PD vs. KT, p = 0.033). Cardiovascular complications were more common in the HD group than in the other groups (p = 0.049). Orthopedic complications were more common in the PD group than in the other groups (p = 0.028). Bleeding was more common in the HD group than in the other groups (p = 0.026). Patient survival was greater in the KT group than in the HD group (p = 0.029). Technique survival was lower in the PD group than in the HD group (p = 0.019). Conclusions: Among patients with ESRD secondary to SLE, KT had better patient survival and lower complication rates than HD and lower complication rates than PD. The prognosis between the HD and PD groups was similar. We conclude that if KT is not a viable treatment option, any alternative treatment should take into account the patient`s general condition and preference. (Korean J Intern Med 2011;26:60-67)
Background/Aims: The aim of this study is to measure the difference of ionized calcium between heparinized whole blood and serum. Methods: We recruited 107 maintenance hemodialysis (HD) patients from our hospital HD unit. The clinical and laboratory data included ionized calcium in serum and in whole blood (reference, 4.07 to 5.17 mg/dL). Results: The level of ionized calcium in serum was higher than that in whole blood (p < 0.001). Bland-Altman analysis showed that difference for ionized calcium was 0.5027. For the difference, the nonstandardized β was -0.4389 (p < 0.001)and the intercept was 2.2418 (p < 0.001). There was a significant difference in the distribution of categories of ionized calcium level between two methods (κ, 0.279;p < 0.001). Conclusions: This study demonstrates that whole blood ionized calcium is underestimated compared with serum ionized calcium. Positive difference increases as whole blood ionized calcium decreases. Therefore, significant hypocalcemia in whole blood ionized calcium should be verified by serum ionized calcium.
In the power plant using high temperature fuel cells such as Molten Carbonate Fuel Cell(MCFC), and Solid Oxide Fuel Cell(SOFC), the generated electric power per area of power generation facilities is much higher than any other renewable energy sources. - High temperature fuel cell systems are capable of operating at MW rated power output. - It also has a feature that is short for length of the line for connecting the interior of the generation facilities. In normal condition, these points are advantages for voltage drops or power losses. However, in abnormal condition such as fault occurrence in electrical system, the fault currents are increased, because of the small impedance of the short length of power cable. Commonly, to minimize the thermal-mechanical stresses on the stack and increase the systems reliability, we divided the power plant configuration to several banks for parallel operation. However, when a fault occurs in the parallel operation system of power main transformer, the fault currents might exceed the interruption capacity of protective devices. In fact, although the internal voltage level of the fuel cell power plant is the voltage level of distribution systems, we should install the circuit breakers for transmission systems due to fault current. To resolve these problems, the SFCL has been studied as one of the noticeable devices. Therefore, we analyzed the effect of application of the SFCL on bus tie in a fuel cell power plants system using PSCAD/EMTDC.
Cranioplasty following decompressive craniectomy is regarded as a relatively simple and safe procedure to protect the brain and improve neurological function. However, some serious complications, such as infection, hematoma, bone resorption, seizure, and epidural or subdural fluid collection may develop after cranioplasty. Among these complications, epidural fluid collection after cranioplasty is not well described and with limited reports on the same. Here, we report recurrent epidural fluid collection after cranioplasty, eventually necessitating the removal of the bone flap. This study discusses the possible pathological mechanisms of this undesirable complication with a review of the literature.
This study proposes two types of current-limiting DC circuit breakers coupled with a superconductor. The first superconductive DC circuit breaker limits the size of the fault current by quenching the superconductor when a fault occurs. Then the limited fault current is blocked by the DC circuit breaker. The second transformer-type superconductive DC circuit breaker limits the fault current and performs blocking operation through the impedance characteristics of the transformer and the quench characteristics of the superconductor. This study analyzes the blocking characteristics of the two types of current-limiting DC circuit breakers. The blocking performance, current limiting rate, and power sharing ratio of the breakers were analyzed using the same simulation conditions for each type of breaker. The simulation results showed that the transformer-type superconductivity DC circuit breaker has the highest fault current limiting rate. Furthermore, the superconductive DC circuit breaker completed the fault current blocking operation the fastest. Finally, it was verified that the applied power burden to the superconductor is lowest at the transformer-type superconductive DC circuit breaker.
Background: We report a case of a spray painter who developed malignant fibrous histiocytoma (MFH) of the maxillary sinus following long-term exposure to chromium, nickel, and formaldehyde, implying that these agents are probable causal agents of MFH. Case report: The patient developed right-sided prosopalgia that began twenty months ago. The symptom persisted despite medical treatment. After two months, he was diagnosed with MFH through imaging studies, surgery, and pathological microscopic findings at a university hospital in Seoul. His social, medical, and family history was unremarkable. The patient had worked for about 18 years at an automobile repair shop as a spray painter. During this period, he had been exposed to various occupational agents, such as hexavalent chromium, nickel, and formaldehyde, without appropriate personal protective equipment. He painted 6 days a week and worked for about 8 hours a day. Investigation of the patient's work environment detected hexavalent chromium, chromate, nickel, and formaldehyde. Conclusions: The study revealed that the patient had been exposed to hexavalent chromium, formaldehyde, and nickel compounds through sanding and spray painting. The association between paranasal cancer and exposure to the aforementioned occupational human carcinogens has been established. We suggest, in this case, the possibility that the paint spraying acted as a causal agent for paranasal cancer.
Background: Advances in bioimpedance analysis (BIA) technologies now enable visceral fat area (VFA) to be assessed using this method. The aim of this study was to evaluate the clinical relevance and usefulness of VFA as a predictor of chronic kidney disease (CKD) and metabolic syndrome (MS), using BIA. Methods: We identifi ed 24,791 adults who underwent voluntary routine health checkups at Yeungnam University Hospital. In total 22,480 patients were recruited into our study. Participants were divided into 3 tertiles based on their VFA: low, middle, and high tertiles. CKD was defi ned as an estimated glomerular fi ltration rate (eGFR) <60 mL/min/1.73 m2. Results: The higher tertile of VFA was associated with a higher prevalence of diabetes mellitus, hypertension, and male sex. Waist-to-hip ratio, body mass index, blood pressure, lean mass, body fat %, and fasting glucose, total cholesterol, triglyceride, GGT, AST, ALT, and uric acid levels all increased as the VFA tertile increased (P < 0.001 for all variables). The prevalence of CKD was 6.9% in the low tertile, 13.9% in the middle tertile, and 25.2% in the high tertile (P < 0.001). The prevalence of MS was 2.2% in the low tertile, 12.8% in the middle tertile, and 36.7% in the high tertile (P < 0.001). The AUROC values for VFA were higher than those for BMI and WHR. For VFA, the sensitivity and specifi city for predicting CKD were 62.66% (95% CI, 61.0-64.3) and 64.22% (95% CI, 63.5-64.9), respectively, and 77.65% (95% CI, 76.3-79.0), and 68.81% (95% CI, 68.1-69.5), respectively for predicting MS. Conclusions: Our results demonstrated that the VFA, measured by BIA, is a simple method for predicting the risk of CKD and MS.