• Tuberculosis and Respiratory Diseases
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• v.56 no.6
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• pp.628-637
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• 2004

Background : Percutaneous needle aspiration biopsy(PNAB) of the lung is a safe procedure for diagnosis of various pulmonary diseases but complications such as pneumothorax can occasionally develop. We reviewed the complications arising after PNAB and analysed the risk factors of pneumothorax. Method : We collected data by reviewing medical records and radiographic studies of 403 patients who underwent PNAB of the lung between 1988 and 2002 and analyzed the risk factors of pneumothorax. Result : The incidence of complication was 12.9%, 48 patients with pneumothorax and 4 patients with mild hemoptysis. Among the 48 pneumothorax patients, 35 patients showed mild(<20%) and was treated by only oxygen supply, 11 patients had severe pneumothorax(>50%) and chest tube insertion was done and 2 patients were treated by needle aspiration. As the results of multivariate analysis, size and location of lesion, location of approach, diagnosis of lesion showed no significant relationship, while age and gender of patients(p<0.05) and the depth of approach(p<0.001) were significantly related to pneumothorax. Smoking amount(p<0.001) as well as the smoking history(p<0.005) were also significantly related and the examiner displaying various incidence of pneumothorax from 4.0% to 23.1% among individuals also was a significant independent risk factor(p<0.05). While the average depth of approach for 13 patients treated by chest tube insertion or needle aspiration was $8.2{\pm}1.2cm$, 35 patiens treated only by oxygen supply was $6.7{\pm}1.6cm$ suggesting that the depth of approach was lead to a severe pneumothorax. Conclusion : The independent risk factors of pneumothorax, the most common complication after PNAB, are age and gender of patients, depth of approach, examiner of procedure, smoking history and smoking amount.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.305-312
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• 2014

Purpose : The purpose of this study is to analyze the mechanical and leaf speed accuracy of the dynamic multileaf collimator (DMLC) and determine the appropriate period of quality assurance (QA). Materials and Methods : The quality assurance of the DMLC equipped with Millennium 120 leaves has been performed total 92 times from January 2012 to June 2014. The the accuracy of leaf position and isocenter coincidence for MLC were checked using the graph paper and Gafchromic EBT film, respectively. The stability of leaf speed was verified using a test file requiring the leaves to reach maximum leaf speed during the gantry rotation. At the end of every leaf speed QA, dynamic dynalog files created by MLC controller were analyzed using dynalog file viewer software. This file concludes the information about the planned versus actual position for all leaves and provides error RMS (root-mean square) for individual leaf deviations and error histogram for all leaf deviations. In this study, the data obtained from the leaf speed QA were used to screen the performance degradation of leaf speed and determine the need for motor replacement. Results : The leaf position accuracy and isocenteric coincidence of MLC was observed within a tolerance range recommanded from TG-142 reports. Total number of motor replacement were 56 motors over whole QA period. For all motors replaced from QA, gradually increased patterns of error RMS values were much more than suddenly increased patterns of error RMS values. Average error RMS values of gradually and suddenly increased patterns were 0.298 cm and 0.273 cm, respectively. However, The average error RMS values were within 0.35 cm recommended by the vendor, motors were replaced according to the criteria of no counts with misplacement > 1 cm. On average, motor replacement for gradually increased patterns of error RMS values 22 days. 28 motors were replaced regardless of the leaf speed QA. Conclusion : This study performed the periodic MLC QA for analyzing the mechanical and leaf speed accuracy of the dynamic multileaf collimator (DMLC). The leaf position accuracy and isocenteric coincidence showed whthin of MLC evaluation is observed within the tolerance value recommanded by TG-142 report. Based on the result obtained from leaf speed QA, we have concluded that QA protocol of leaf speed for DMLC was performed at least bimonthly in order to screen the performance of leaf speed. The periodic QA protocol can help to ensure for delivering accurate IMRT treatment to patients maintaining the performance of leaf speed.

• Tuberculosis and Respiratory Diseases
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• v.64 no.1
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• pp.8-14
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• 2008

Background: Acinetobacter infections are difficult to treat as they often exhibit multiple resistance to the antibiotics that are currently available for the treatment of pneumonia. Colistin is active against gram-negative bacteria, including the multiple drug resistant (MDR) Acinetobacter species. However, intravenous administration of colistin was abandoned because of its nephrotoxicity and neurotoxicity. The aims of this study were to examine the efficacy and safety of colistin administered by aerosol in the treatment of pneumonia caused by MDR Acinetobacter baumannii. Methods: We retrospectively reviewed the medical records of patients admitted to the intensive care unit (ICU) from Dec. 2006 to Aug. 2007 who had been diagnosed as suffering from pneumonia due to MDR Acinetobacter baumannii and had been treated with nebulized colistin. Results: 31 patients received aerosolized colistin. The average duration of the treatment was $14{\pm}7$ days and the daily dose of ranged from 225 mg to 300 mg. All patients received concomitant intravenous antimicrobial agents. The average length of the stay in the ICU was $34{\pm}21$ days and in the hospital $58{\pm}52$ days. The overall microbiological eradication was observed in 25 patients (80.6%). 14 of these (56%) were cured, and 11 (44%) were infected with other microorganisms. The overall crude mortality of the ICU was 48%. Nephrotoxicity and significant bronchial constriction did not occur in any patient during neublized colistin treatment. Conclusion: Nebulized colistin may be a safe and effective option in the treatment of pneumonia due to MDR Acinetobacter baumannii. Its role in therapy warrants further investigation in comparative studies.

• Neonatal Medicine
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• v.18 no.2
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• pp.320-327
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• 2011

Purpose: To determine the effect of changing practice guidelines designed to avoid hyperoxia or hypoxia in very low birth weight or very preterm infants. Methods: We analyzed a database of <1,500 g birth weight or <32 weeks of gestation infants who were born and admitted to the neonatal intensive care unit of Chungnam National University Hospital from January 2007 to July 2010. First, we defined the relationship between arterial partial pressure of oxygen ($PaO_2$) and pulse oxygen saturation ($SpO_2$). When we evaluated 96 pairs of $PaO_2$ and $SpO_2$ measurements, oxygen saturation was 90-94% at a $PaO_2$ of 43-79 mmHg on the oxyhemoglobin dissociation curve, according to pulse oximetry. Based on this observation, a change in practice was instituted in August 2008 with the objective of avoiding hypoxia and hyperoxia in preterm infants with targeting a $SpO_2$ 90-94% (period II). Before the change in practice, high alarms for $SpO_2$ were set at 100% and low alarms at 95% (period I). Results: Sixty-eight infants the met enrollment criteria and 38 (56%) were born during period II, after the change in $SpO_2$ targets. Demographic characteristics, except gender, were similar between the infants born in both periods. After correcting for the effect of confounding factors, the rates for mortality, severe retinopathy of prematurity, and IVH attended to be lower than those for infants in period II. No difference in the rate of patent ductus arteriosus needed to treat was observed. Conclusion: A change in the practice guidelines aimed at avoiding low oxygen saturation and hyperoxia did not increase neonatal complication rates and showed promising results, suggesting decreased mortality and improvements in short term morbidity. It is still unclear what range of oxygen saturation is appropriate for very preterm infants but the more careful saturation targeting guideline should be considered to prevent hypoxemic events and hyperoxia.

• Neonatal Medicine
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• v.18 no.2
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• pp.265-271
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• 2011

Purpose: Extended spectrum $\beta$-lactamase (ESBL) producing organism is an important cause of infections in the neonatal intensive care unit (NICU) since 1990s. The aim of this study is to investigate the differences of clinical characteristics and hematologic studies between neonates with ESBL-positive organism and those with ESBL-negative organism. Methods: The subjects included 48 neonates admitted to NICU at Inje University Sanggye Paik Hospital from January 2005 to September 2010, from whom a total of 58 Escherichia coli or Klebsiella pneumonia were detected. The data were categorized in 2 groups, neonates with ESBL-positive and ESBL-negative. We compared clinical characteristics and hematologic studies between two groups. Results: Of 48 neonates and 53 isolates, ESBL-positive were 18 neonates and 20 isolates. Both ESBL-positive and ESBL-negative isolates were largely found in urine, each with 10 and 23. Of 20 ESBL-positive isolates, 13 (65%) and 7 (35%) were ESBL producing Escherichia coli and Klebsiella pneumonia, respectively. ESBL-positive neonates were associated with low 1 and 5 minutes Apgar scores (P=0.002 and P=0.001, respectively), more uses of oxygen (56% vs. 27%; P=0.005), longer duration of oxygen uses (15.8${\pm}$38.43 days vs. 4.3${\pm}$12.5 days; P=0.008) and more frequent anemia (33% vs. 7%; P=0.040). Conclusion: ESBL-positive neonates may have more anemia and lower Apgar score at birth. We can consider the use of cabapenem earlier if infant with previous antibiotics is confirmed to be infected with ESBL-positive organisms.

• Journal of Hospice and Palliative Care
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• v.20 no.3
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• pp.177-187
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• 2017

Purpose: From August 2017, hospice-palliative care (HPC) will be provided to patients with acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), and liver cirrhosis in Korea. To contribute to building a non-cancer (NC) hospice-palliative care model, NC specialists were interviewed regarding the goals, details, and provision methods of the model. Methods: Four physicians specializing in HPC of cancer patients formulated a semi-structured interview with questions extracted from literature review of 85 articles on NC HPC. Eleven NC disease specialists were interviewed, and their answers were analyzed according to the qualitative content analysis process. Results: The interviewees said as follows: It is difficult to define end-stage NC patients. HPC for cancer patients and that for NC patients share similar goals and content. However, emphasis should be placed on alleviating other physical symptoms and emotional care rather than pain control. Timing of the care provision should be when patients are diagnosed as "end stage". Special issues should be considered for each NC disease (e.g., use of anti-retroviral drugs for AIDS patients, oxygen supply for COPD patients suffering from dyspnea, liver transplantation for patients with liver cirrhosis) and education should be provided to healthcare professionals. NC patients tend to negatively perceive HPC, and the government's financial assistance is insufficient. Conclusion: It is necessary to define end-stage NC patients through in-depth discussion to minimize issues that will likely accompany the expansion of care recipients. This requires cooperation between medical staff caring for NC patients and HPC givers for cancer patients.

• Horticultural Science & Technology
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• v.29 no.5
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• pp.447-455
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• 2011

To investigate the effects of the improvement of postharvest quality on fresh tomato, antimicrobial microperforated (AMP) films were prepared and their antimicrobial abilities were observed. AMP films were made by coating different types of natural antimicrobial agents such as cinnamon, clove, and clary sage essential oils into microperforated (MP) films. Cinnamon essential oil of 10% (v/v) has proven to be very effective as inhibitor of the mold growth on tomato, compared to the clove and clary sage essential oils. Quality changes of fresh tomatoes packed using the natural AMP films (AMP10 and AMP30) and MP films (MP10 and MP30) during storage were evaluated. Total microbial growth, weight loss, firmness, lycopene content, and decay rate as the major quality parameters were monitored over 9 days at $15^{\circ}C$. The oxygen transmission rates and mechanical properties between the natural AMP and MP films were also compared. There was no significant difference in change of oxygen transmission rate, tensile strength and elongation between the AMP and MP films. For storage studies, the freshness of tomato packaged in AMP30 film was higher than that in OPP film (the control), MP10, MP30, and AMP10 films. Especially, AMP30 film exhibited high efficiency compared to the control for tomato decay during storage periods. Based on the results, the microperforation and antimicrobial properties of the packaged films may significantly affect the maintenance of an optimum gas composition within the package atmosphere for increasing the storage life and quality of produce. They were also effective on the inhibition of microbial growth by controlled release of antimicrobial agent at an appropriate rate from the package into the tomato. Natural antimicrobial agent coating microperforated films could use potential functional package as a method of extending the freshness of postharvest tomato for storage.

• Tuberculosis and Respiratory Diseases
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• v.39 no.5
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• pp.425-432
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• 1992

Background: The prevalence of tuberculosis in Korea decreased remarkably for the past 30 years, while for at least the recent 10 years, the frequency of disease attributable to mycobacteria other than tuberculosis (MOTT) began to increase both in actual numbers and in the proportion of the total burden of mycobacterioses. Method: Twenty nine cases, diagnosed as having pulmonary disease due to MOTT on the basis of repeated isolations of the relevant organisms from sputum specimens and chest X-ray findings from Jan. 1982 throught Dec. 1991 at the Chest Clinic of the Korean Institute of Tuberculosis, were reviewed in terms of clinical features and courses. Results: 1) Nineteen cases (66%) were infected with Mycobacterium avium-intracellulare, 5 cases (17%) with M. fortuitum, 4 cases (14%) with M. chelonei, and 1 cases (3%) with M. szulgai. 2) The ratio of male versus female patients was 1.9:1. 3) The peak incidence was in the fifth decade. 4) Eighteen cases (62%) had moderately advanced disease and 11 cases (38%) had far advanced disease on chest P-A film. 5) The common symptoms were cough (59%), sputum (52%), and dyspnea (34%). 6) All cases had a previous history of tuberculosis. 7) Most of the isolates were highly resistant to the major antituberculosis drugs and 48~52% showed a sensitivity to cycloserine, kanamycin or enviomycin. 8) Of 19 cases which were treated and followed-up for over 12 months, 3 cases attained negative conversion on cultures (2 M. fortuitum infections, 1 M. szulgai infection). Sixteen cases failed in attaining negative conversion on cultures. However, their clinical courses were chronic and indolent despite of persistant culture positivity. Conclusion: Treatment of these patients has been difficult because of the frequency of severe underlying conditions and the natural resistance of most of the nontuberculous mycobacteria to the presently available drugs.

• The Korean Journal of Mycology
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• v.10 no.3
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• pp.119-124
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• 1982

The characteristics of the six different agricultural soil from Michigan were as follows. Colwood and Capac soil were loam, Gilford and Ceresco were sandy clay loam, Sission was clay loam, and Spinks was sandy loam. pH of Gilford sandy clay loam was 6.6 whereas that of the soil ranged $5.4{\sim}5.9$. Gilford sandy loam found to contain a relatively higher amount of organic matters as compared to other soils. Furthermore, the numbers of bacteria in Gilford sandy clay loam were significantly higher than those in other soils. The populations of fungi in Gilford sandy clay loam and Colwood loam soils were significantly greater than those in other soils. On the other hand, the densities of actinomycetes in Gilford sandy clay loam and Ceresco sandy clay loam soils were significantly different from those in other soils. The population of anaerobic bacteria varied depending on the soils; Ceresco sandy clay loam, Capac loam, Colwood loam soils have higher numbers of bacteria, whereas Gilford sandy clay loam was very lesser than the other soils. In the $^{14}C-glucose$ respiration by soil microorganisms after 10 hrs, the respiration rate was decreasing in the order of Ceresco sandy clay loam, Spinks sandy loam, Colwood loam, Sission clay loam, Capac loam and Gilford sandy clay loam. Germination of test propagules on natural soil soil was $0{\sim}5%$, and it was germinated $90{\sim}98%$ on autoclaved soil and PDA. The propagules differed in thier germination response to nutrients added to the soils. In general, more nutrients were required to promote germination on Capac loam and Gilford sandy loam soil than Spinks sandy loam soil. Especially Mortierella n. sp. required more nutrients for germination to obtain the same ratio as Helminthosporium victoriae.

• Clinical and Experimental Pediatrics
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• v.46 no.5
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• pp.447-453
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• 2003

Purpose : This study was performed to compare complications and perinatal factors according to the birth weight groups in the infants of diabetic mothers(IDM). Methods : Three hundred and one singleton diabetic mothers and their babies of more than 30 weeks' gestational age admitted in the department of Pediatrics, Chonnam University Hospital from January 1996 to March 2002 were enrolled. Complications and perinatal factors were compared between large for gestational age(LGA) and appropriated for gestational age(AGA) infants. Results : Hypomagnesemia was observed in 37.5%, jaundice in 21.3%, hypoglycemia in 11.1%, hypocalcemia in 7.0%, and birth injury in 19.6%. Congenital anomaly was noted in 24.9% with cardiovascular anomaly most commonly. In the LGA group, the frequencies of jaundice, hypoglycemia, tachypnea, and birth injuries were higher, and the interventricular septum was thicker than the AGA group. In the LGA group, Cesarean section rate, maternal height, weight before pregnancy, weight gain during pregnancy, and the incidence of unawareness of gestational DM were significant compared with the AGA group. Conclusion : In the LGA group, the frequencies of jaundice, hypoglycemia, tachypnea, and birth injuries were higher, and the interventricular septum was thicker than the AGA group. In the LGA group, maternal height, weight before pregnancy and weight gain during pregnancy were larger, and the incidence of unawareness of gestational DM was higher compared with the AGA group. These results suggest that careful examination and management are needed to detect the high risk, pregnant DM mothers with possible LGA babies.