Background: Although we gain new knowledge, the problem of pneumonia will not be eliminated. We should understand who is at risk, why these people develop this problem, what causes the pneumonia, and how to manage and prevent respiratory infection. To clarify the alterations of the etiologies of bacterial pneumonia we analysed the recent causative organisms and evaluated the therapeutic implications. Methods: A retrospective four-year study of bacterial pneumonia was conducted in Soon Chun Hyang University Hospital. 190 episodes of bacterial pneumonia was investigated. Results: 1) The causative organisms were isolated in 173 cases on the sputum culture: 154 cases (89%) were gram negative bacilli and 19 cases(11%) were gram positive cocci. The major organisms were Pseudomonas species 49 cases(28%), Klebsiella pneumoniae 29 cases(17%), Enterobacter species 25 cases(14%), and Acinetobacter species 20 cases(12%) in decreasing order. Pseudomonas species(13 cases, 34%) were frequently found in nosocomial pneumonia. 2) The causative organisms were isolated in 16 cases on the blood culture: 7 cases(43%) were gram negative bacilli and 9 cases(57%) were gram positive cocci. The major organisms were Staphylococcus aureus(6 cases, 38%), Pseudomonas species(3 cases, 19%) in decreasing order. 3) In the susceptibility test of causative organisms to antimicrobial drugs, Pseudomonas was susceptible to amikacin, ciprofloxacin, aztreonam, ceftazidime(more than 50%) and resistant to piperacillin, gentamicin, carbenicillin(more than 60%). Klebsiella was susceptible to chloramphenicol, gentamicin, cefotetan(more than 70%) and resistant to carbenicillin, ampicillin(more than 70%). Staphylococcus was susceptible to methicillin(64%), and Streptococcus pneumoniae was susceptible to oxacillin(94%). 4) The response rate after antibiotics therapy was 81% and the mortality rate was 19%. Conclusion: As considering the changes of causative organisms and antibiotic resistance, it behooves us to exercise caution in dispending antibiotics in order to maximize their continued efficacy and to do appropiate antibiotics therapy based on cultures and susceptibility test.
Kim, Chang Hwi;Cha, Sung Ho;Shin, Son Moon;Kim, Chun Soo;Choi, Young Youn;Hong, Young Jin;Chey, Myoung Jae;Kim, Kwang Nam;Hur, Jae Kyun;Jo, Dae Sun;Kim, Sung Shin;Lee, Sang Lak;Song, Eun Song;Ramakrishnan, Gunasekaran;Ok, Jin Ju;Van Der Meeren, Olivier;Bock, Hans L.;Kim, Jung Soo
Pediatric Infection and Vaccine
/
v.17
no.2
/
pp.156-168
/
2010
Purpose : To compare immunogenicity and reactogenicity of a combined diphtheria-tetanus-acellular pertussis-inactivated poliovirus vaccine (DTPa-IPV, $Infanrix^{TM}$ IPV, GlaxoSmithKline Biologicals) with co-administration of commercially available DTPa and IPV vaccines at separate injection sites (DTPa+IPV). Methods : A total of 458 infants aged 8-12 weeks were randomized to receive three-ose primary vaccination at 2, 4 and 6 months with DTPa-IPV or DTPa+IPV. Blood samples were collected pre and post vaccination for measurement of immune responses. Reactogenicity was assessed following each dose using diary cards. Results : One month post-dose 3, seroprotection rates for anti-diphtheria, anti-tetanus and anti-poliovirus types 1, 2 and 3 were ${\geq}99.5%$ and vaccine response rates to pertussis antigens were at least 98.6% in both DTPa-IPV and DTPa + IPV groups. Non-inferiority between the groups was demonstrated based on pre-defined statistical criteria. Incidences of both local and systemic symptoms were within the same range across both groups with grade 3 symptoms reported following no more than 4.3% of DTPa-IPV doses and 4.5% of DTPa + IPV doses. Two serious adverse events (both pyrexia) after DTPa-IPV administration were considered vaccine-related. Both infants recovered fully. Conclusion : Combined DTPa-IPV vaccine was immunogenic and well tolerated when used as a three-dose primary vaccination course in Korean infants. DTPa-IPV could be incorporated into the Korean vaccination schedule, reducing the number of injections required to complete primary immunization.
Purpose : To investigate the feasibility and accuracy of Proton Resonance Frequency (PRF) shift based magnetic resonance (MR) temperature mapping utilizing the self-developed center array-sequencing phase unwrapping (PU) method for non-invasive temperature monitoring. Materials and Methods : The computer simulation was done on the PU algorithm for performance evaluation before further application to MR thermometry. The MR experiments were conducted in two approaches namely PU experiment, and temperature mapping experiment based on the PU technique with all the image postprocessing implemented in MATLAB. A 1.5T MR scanner employing a knee coil with $T2^*$ GRE (Gradient Recalled Echo) pulse sequence were used throughout the experiments. Various subjects such as water phantom, orange, and agarose gel phantom were used for the assessment of the self-developed PU algorithm. The MR temperature mapping experiment was initially attempted on the agarose gel phantom only with the application of a custom-made thermoregulating water pump as the heating source. Heat was generated to the phantom via hot water circulation whilst temperature variation was observed with T-type thermocouple. The PU program was implemented on the reconstructed wrapped phase images prior to map the temperature distribution of subjects. As the temperature change is directly proportional to the phase difference map, the absolute temperature could be estimated from the summation of the computed temperature difference with the measured ambient temperature of subjects. Results : The PU technique successfully recovered and removed the phase wrapping artifacts on MR phase images with various subjects by producing a smooth and continuous phase map thus producing a more reliable temperature map. Conclusion : This work presented a rapid, and robust self-developed center array-sequencing PU algorithm feasible for the application of MR temperature mapping according to the PRF phase shift property.
Water quality of effluent from wastewater treatment plants (WWTPS) was reviewed to examine the feasibility of agricultural reuse using USEPA and WHO guidelines. It might meet the guidelines for BOD and SS, however, the most critical microbiological concentration was too high and further treatment is required. The pilot study of three treatments were performed to reduce microbiological concentrations. The UV irradiation was proved to be very effective in disinfection of secondary level effluent, and about 30 mW ${\cdot}$ s/$cm^2$ of dose was suggested to meet the even most stringent USEPA guidelines. Slow sand filter demonstrated effective removal of bacteria, and effluent concentration of total coliform (TC), fecal coliform (FC), and E. coli. dropped from about 10,000/100 mL to 300, 200, and 150 MPN/100 mL, respectively, showing over 95% removal. These level of bacterial concentration sufficiently meet the WHO guidelines ($10^3\;{\sim}\;10^5$ FC/100 mL), and could meet the more stringent USEPA guidelines (200 FC/100 mL) if properly applied. Slow sand filter also provided about 50% removal of SS, turbidity, and BOD in addition to bacterial removal. The removal efficiency of pond system was relatively poor, but still showed over 85% removal and effluent concentration of TC, FC, and E. coli was all below 10,000/100 mL. The pond system alone could meet the WHO guidelines, but hardly meet the USEPA guidelines and further treatment might be necessary. Overall, three methods evaluated in the study treat the effluent to meet the WHO microbiological guidelines for agricultural reuse. The UV disinfection and slow sand filter might also could the USEPA guidelines, while the pond system can hardly meet the USEPA guidelines if applied alone. The WHO and USEPA guidelines were made based on data from upland field agricultural system and may not be directly applicable to the paddy field agricultural system. Therefore, national standards for agricultural reuse of reclaimed water should be made considering domestic agricultural systems as well as international guidelines. Also, further investigation is recommended to develop optimum and feasible treatment measures for agricultural reuse of effluent from WWTPs.
This study was performed to develop a formulation using an antagonistic bacterium Bacillus amyloliquefaciens A-2 to control tomato leaf mold caused by Fulvia fulva. B. amyloliquefaciens A-2 was grown in a medium with rice oil and mixed with various carrier and additives. One of the formulations, A2-MP, showed the best disease control value among the tested formulations. The disease control value of A2-MP at 100-fold and 500-fold diluted treatment was not significantly different from that of chemical fungicide triflumizole in a growth chamber. Although disease control effect was decreased by serial diluted treatment of the prepared A2-MP, 1,000-fold diluted treatment of A2-MP still showed high disease control value of 72.0%. For the green house experiments, the disease control values of A2-MP was indicated as 79.4% which is similar to that of chemical fungicide, triflumizole showing 79.6%. When the disease control activity of the formulation A2-MP was compared in tomato production conditions, disease control values of 100-fold diluted A2-MP and 3,000 fold diluted triflumizole exhibited 60%, 81.6%, respectively. The disease control efficiency by A-2MP was 73% of the disease control value of chemical fungicide. The formulation A-2MP maintained the stable bacterial viability and disease control activity when stored at $4^{\circ}C$. This result suggested that A-2MP develped from B. amyloliquefaciens A-2 could be used to control tomato leaf mold.
Background: The surgical technique for biventricular assist device(BVAD) implantation has mainly consisted of cannulation procedures. A median sternotomy has been the technique of choice as it gives a surgeon an excellent exposure of the heart. However, considering that most patients require a future sternotomy or already have a previous sternotomy, sternotomy-related complication remains a major concern in BVAD implantation. Based on this consideration as well as the clinical experiences of conventional heart surgery, the authors have hypothesized that the cardiac chambers for BVAD cannulation can be approached from the right side of the heart. The purpose of this studs to develop a novel surgical technique of right thoracotomy for BVAD implantation in an animals study. Material and Method: For last two years, 16 (11 calves, 3 canines, and 2 sheep) out of 30 experimental animals with AnyHeart implantation underwent a right thoracotomy. The device was used as an implantable BVAD in 14 animals, a wearable BVAD in 1, and an implantable LVAD in 1. The chest cavity was entered through the 4th intercostal space or the 5th periosteal bed. As for the BVAD use, a right inflow cannula was inserted into the right atrial free wall and a right outflow cannula was grafted onto the main pulmonary artery. A left inflow cannula was inserted into the interatrial groove and a left outflow cannula was grafted on the innominate artery of the ascending aorta. The connecting tubes were brought out through the thoracotomy wound and connected to the pump located in the subcutaneous pocket at the right flank. Result: Except for the 5 animals for a lilting test or during the early learning curve, all recovered smoothly from the procedures. The inflow drainage allowed the pump output 6.5 L/min at the maximum with 3-3.5 L/min in an average. Of the survivors, there noted no procedure-related mortality or morbidity. Necropsy findings demonstrated the well-positioned cannula tips in the each cardiac chamber
Background: Postinfarction ventricular septal rupture is associated with mortality as high as $85\sim90%$, if it is treated medically. This report documents our experience with postinfarction ventricular septal rupture that was treated surgically, Material and Method: We retrospectively reviewed the medical records of 11 patients who were operated on due to postinfarction ventricular septal rupture between August 1996 and August 2006. There were 4 men and 7 women, with a mean age of $70{\pm}11$ years (age range: $50\sim84$ years). The location of the rupture was anterior in 7 cases and posterior in 4 cases. The interval between the onset of acute myocardial infarction and the occurrence of the ventricular septal rupture was $2.0{\pm}1.3$ days (range: $1\sim5$ days). Operation was performed at an average of $2.4{\pm}2.7$ days (range: $0\sim8$ days) after the diagnosis of septal rupture. Preoperative intraaortic balloon pump therapy was performed in 10 patients. Result: The infarct exclusion technique was used in all cases. Coronary artery bypass grafting was done in 8 cases, with the mean number of distal anastomosis being $1.0{\pm}0.8$. There was one operative death. In 2 patients, reoperation was performed due to a residual septal defect. The postoperative morbidities were transient atrial fibrillation (n=7), paroxysmal supraventricular tachycardia (n=1), low cardiac output syndrome (n=3), bleeding reoperation (n=2), delayed sternal closure (n=2), acute renal failure (n=2), pneumonia (n=1), intraaortic balloon pump-related thromboembolism (n=1), and transient delirium (n=2). Nine patients have been followed up for a mean of $38{\pm}40$ months except for one follow-up loss. There have been 3 late deaths. At the latest follow-up, all 6 survivors were in a good functional class. Conclusion: We demonstrated satisfactory operative and midterm results with our strategy of preoperative intraaortic balloon pump therapy, early repair of septal rupture by infarct exclusion and combined coronary revascularization.
Ionizing radiation is most widely used for X-Ray examination among all artificial radiation exposure, it takes up the largest proportion. Even in Korea, the medical exposure by diagnostic X-Ray examination takes up 17.4% of all radiation exposure. It takes up 92% even in artificial radiation exposure. There were 111,567 cases X-Ray radiography for skull diagnosis in 2007, which is 3% annual increase since 2004. Thus, It is need to establish the diagnostic reference level and the medical facilities as a diagnostic reference level to optimize radiation protection of the patients and to reduce the doses of X-ray. In this paper, we survey patient dose on skull radiography - collected from 114 medical facilities nationwide by using human phantom and glass dosimeter. When the patient dose for the skull radiography was measured and evaluated to establish the diagnostic reference level, 2.23 mGy was established for posterior-anterior imaging and 1.87 mGy for lateral imaging was established. The posterior-anterior skull radiography entrance surface dose of 2.23 is less than the guidance level of 5 mGy from the global organizations such as World Health Organization (WHO) and International Atomic Energy Agency (IAEA), and 1.87 mGy for the lateral skull imaging is less than the guidance level of 3 mGy, which is guided by the global organizations such as World Health Organization (WHO) and International Atomic Energy Agency (IAEA).
A thermal neutron beam facility utilizing a typical tangential beam port for Neutron Capture Therapy was installed at the HANARO, 30 MW multi-purpose research reactor. Mixed beams with different physical characteristics and relative biological effectiveness would be emitted from the BNCT irradiation facility, so a quantitative analysis of each component of the mixed beams should be performed to determine the accurate delivered dose. Thus, various techniques were applied including the use of activation foils, TLDs and ionization chambers. All the dose measurements were perform ed with the water phantom filled with distilled water. The results of the measurement were compared with MCNP4B calculation. The thermal neutron fluxes were $1.02E9n/cm^2{\cdot}s\;and\;6.07E8n/cm^2{\cdot}s$ at 10 and 20 mm depth respectively, and the fast neutron dose rate was insignificant as 0.11 Gy/hr at 10 mm depth in water The gamma-ray dose rate was 5.10 Gy/hr at 20 mm depth in water Good agreement within 5%, has been obtained between the measured dose and the calculated dose using MCNP for neutron and gamma component and discrepancy with 14% for fast neutron flux Considering the difficulty of neutron detection, the current study support the reliability of these results and confirmed the suitability of the thermal neutron beam as a dosimetric data for BNCT clinical trials.
For highly efficient operation of a Bunsen process section in an iodine-sulfur thermochemical hydrogen production cycle using nuclear heat, the process characteristics of $H_2SO_4-HI-H_2-O-I_2$ mixture system for separating into two liquid phases ($H_2SO_4$-rich phase and $HI_x$-rich phase) and the distribution of $H_2O$ to each phase were investigated.The experiments for process variables were carried out in the temperature range, from 298 to 353 K, and in the $H_2SO_4/HI/H_2O/I_2$ molar ratio of 1/2/14~20/0.5~8.0. As the results, for the $SO_2-I_2-H_2O$ Bunsen reaction system, the ranges between the starting point and the saturation point for two liquid phases separation were determined by calculation. The best result for the minimization of impurities (HI and $I_2$ in $H_2SO_4$ phase and $H_2SO_4$ in $HI_x$ phase) in each phase was obtained in an optimum condition with the highest temperature of 353 K and the highest $I_2$ molar composition. In this condition, the $HI/H_2SO_4$ molar ratio in the $H_2SO_4$-rich phase and the $H_2SO_4/HI_x$ molar ratio in the $HI_x$-rich phase were 0.024 and 0.028, respectively. For the distribution of $H_2O$ to each phase, it is appeared that the affinity between $HI_x$ and $H_2O$ was more superior to that between $H_2SO_4$ and $H_2O$. The affinity between $HI_x$ and $H_2O$ was decreased with increasing temperature but increased with increasing $I_2$ molar composition.
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