• Journal of the korean academy of Pediatric Dentistry
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• v.30 no.1
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• pp.61-68
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• 2003

Streptococcus mutans is known to be a major causative organism of human dental caries. The development of a vaccine against dental caries involves identification of appropriate antigens of mutans streptococci against which protective immune responses can be mounted, and the selection of a method of immunization that will generate sustained levels of protective antibodies. Antigens receiving most attention include streptococcal surface proteins that are involved in attachment to tooth surfaces and glucosyltransferases (GTF) that synthesize adhesive glucans from sucrose. The induction of antibody responses to orally administered antigens is often difficult due to digestive destruction of antigens and immune tolerance. Here we report the induction of antibody responses to an anti-caries vaccine containing retinoic acid (RA). Subcutaneous immunization with formalin-fixed bacteria or GTF supplemented with RA induced higher serum IgM and IgA responses to GTF compaired to oral adminstration. Antisera induced by Ingbritt strain showed partial cross-reaction with LM-7 strain, but not with OMZ175. These results suggest that subcutaneous immunization with GTF combined with an immunomodulator, RA, may be applied to anti-caries vaccine.

• Journal of Hospice and Palliative Care
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• v.20 no.2
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• pp.93-99
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• 2017

Purpose: This study investigated changes in life-sustaining treatments in terminally ill cancer patients after consenting to a do-not-resuscitate (DNR) order. Methods: Electronic medical records were reviewed to select terminally ill cancer patients who were treated at the oncology unit of the Asan Medical Center, a tertiary hospital in South Korea and died between January 1, 2013 and December 31, 2013. Results: The median (range) age of the 200 patients was 59 (22~89) years, and 62% (124 persons) were male. Among all patients, 83.5% were aware of their medical condition, and 47.0% of the patients had their DNR order signed by their spouses. The median of the patients' hospital stay was 15 days, and time from admission to DNR decision was 10 days. After signing a DNR order, 35.7~100% of the life-sustaining treatments that had been provided at the time of the DNR decision making were administered. The most commonly discontinued interventions were transfusion (13.5%), blood test (11.5%) and parenteral nutrition (8.5%). Conclusion: It is necessary to define the scope of life-sustaining treatments for DNR patients. Treatment guidelines should be established as well to secure terminal patients' death with dignity after their consent to a DNR order, thereby avoiding meaningless life-sustaining treatments and allowing administration of active terminal care interventions.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.3 no.1
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• pp.63-67
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• 2000

Purpose: Biliary atresia, one of the major causes of neonatal cholestais, is an idiopathic, serious disorder, affecting the newborn that results in complete obstruction of biliary tract. Successful reestablishment of bile flow is dependent on early surgical intervention, early diagnosis is imperative. The authors evaluate the utility of Tc-99m-labeled diisoprpyliminodiacetic acid (DISIDA) hepatobiliary scintigraphy in the diagnosis of biliary atresia. Methods: From January, 1995 to August, 1999, total 60 patients with neonatal cholestasis underwent Tc-99m DISIDA hepatobiliary scintigraphy at Asan Medical Center. Results: The undelying causes of neonatal cholestasis were biliary atresia in 14, neonatal hepatitis in 33, intrahepatic bile duct paucity in 9, and total parenteral nutrition induced cholestasis in 4. All patient with biliary atresia were interpreted correctely in DISIDA hepatobiliary scintigraphy, showing 100% sensitivity. Of the 46 patients with neonatal hepatitis and other causes, 37 patients had intestinal radioactivity showing 80% specificity. Conclusion: Visualization of DISIDA in the intestinal tract indicates patency of the biliary ducts and excludes the diagnosis of biliary atresia. But the absence of intestinal excretion on the DISIDA hepatobiliary scintigraphy dose not necessarily indicate biliary atresia.

• Journal of fish pathology
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• v.19 no.2
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• pp.155-164
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• 2006

Tissue distribution and residue depletion of oxytetracycline (OTC) and tetracycline (TC) following dipping administration were evaluated in olive flounder (Paralichthys olivaceus), rockfish (Sebastes schlegeli), and red sea bream (Pagrus major) under field conditions. Fishes were held in floating cages placed in sea water and fed a commercial diet for 15 days to acclimate to a new surrounding. Fishes were dipped in OTC 50 g/ton water for 30min and TC 18 g/ton water for 5 hours. Blood and muscle were sampled from fishes on 0th, 1th, 2th, 3th, and 5th day after administration. After solid-phase extraction, OTC and TC analyses were carried out by HPLC. The recovery rate of OTC in serum and muscle samples was 71-77% and 78-84%, respectively. Also, the recovery rate of TC in serum and muscle samples was 70-79% and 73-78%, respectively. The results of recovery rate were similar to previous studies reported. At the termination of dipping administration of OTC and TC, residue concentration in muscle samples of rockfish was significantly higher than those of olive flounder and red sea bream. At day 5, residue concentrations of all samples were believed to decrease to lower than 0.05 mg/kg, the detection limit. The present study showed that residue concentrations of OTC and TC decreased to below 0.05 mg/kg after treatment 5th day, faster than the established withdrawal period. The tissue reside depletion time of dipping administration of OTC and TC seems to be shorter than those of oral or parenteral administration.

• Journal of Home Health Care Nursing
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• v.14 no.1
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• pp.31-41
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• 2007

Purpose: This study was designed to evaluate the effect of home care nursing intervention with parenteral hydration and IV anti-emetic therapy on distress, nutritional status, anxiety, depression and QOL in gynecologic cancer patients who were undergoing combination chemotherapy. Methods: Quasi-experimental design was used to test the intervention. Changes of result variables were measured to evaluate effects of the intervention. variables consisted of serum lab results(auto analytic equipment for lab), symptom distress Scale(McCorkle & Young, 1978; Song et al., 2000), nutritional status(body weight, circumference of upper arm, serum protein, serum albumin, oral intake per day), anxiety(Spielberger, 1972; Kim & Shin, 1978), depression(Zung, 1965; Kim, 1995) and QOL(Padilla et al., 1983; Lee & Jo, 1996). Subjects were selected among gynecologic cancer patients(EG 15 patients and CG 15 patients) by convenient sampling. Data collection was done from June to Nov. in 2000. Data were analyzed by Chi-test and Mann-whitney U test using SPSS Win 10.0. Result: Hypothesis 1, the EG receiving this intervention equals to lab test(Hb & ANC, GOT & GPT, BUN & Cr) the CG, was supported(u=69.50 p=.074; u=94.50, p= .455; u= 89.50, p= .339; u=106.50, p= .803; u=75.00, p= .119; u=97.50, p= .523). Hypothesis 2, the EG has less symptom distress than the CG, was also supported(u=43.50, p= .004). Hypothesis 3, the EG has higher nutritional status than the CG, was partially supported on daily oral intake (u=59.00, p= .025). Hypothesis 4, the EG has less anxiety than the CG, was rejected(u=86.50, p= .280). Hypothesis 5, the EG has less depression than the CG, was rejected(u=203.50, p= .228). and the last hypothesis 6, the EG has higher QOL than the CG was supported (u=51.50, p= .011). Conclusion: Home care nursing intervention undergone in this study was found to be effective to reduce patients' symptom distress and to improve their oral intake and QOL.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.6
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• pp.427-431
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• 2018

We report a case of a patient with necrotizing fasciitis followed by liver abscess. A 51-year-old man was admitted to our hospital with a 5-day history of fever and chills with painful swelling of the right thigh. A magnetic resonance imaging (MRI) scan showed fluid collection with numerous dark signal intensities considered as air-bubbles between the posteromedial and posterolateral groups of the right thigh, resulting in presumptive diagnosis of necrotizing fasciitis. At the time of admission, an ultrasonograph of the abdomen showed increased parenchymal echogenicity of both kidneys and no liver abscess. Ten days after fasciotomy, an abdominal computed tomography (CT) scan showed intrahepatic abscess. Sonography-guided percutaneous drainage was performed. Both cultures of pus specimens from the liver abscess and right thigh yielded Klebsiella pneumoniae (K. pneumoniae). The patient was treated with fasciotomy several times and parenteral antibiotics, after which he began to improve. After 5 weeks, liver abscess size was reduced, and after 10 weeks, liver abscess disappeared. To the best of our knowledge, this is the first case of K. pneumoniae-necrotizing fasciitis followed by liver abscess.

• Journal of Hospice and Palliative Care
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• v.15 no.1
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• pp.30-35
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• 2012

Purposes: Most medical schools in Korea do not provide adequate education in end-of-life care. This study was designed to illustrate the need to improve end-of-life care education and to assess the effect of the education on fourth-year medical students' awareness and attitude towards hospice and palliative care for terminally ill patients. Methods: One hundred sixty six fourth-year medical students were surveyed with questionnaires on end-of-life care before and after they received the education. Results: Before receiving the education, students most frequently answered "at the end of life" (33.6%) was appropriate time to write an advance medical directive. After the education, the most frequent answer was "in healthy status" (58.7%). More students agreed to withholding or withdrawing futile life-sustaining treatment increased after the education (48.1% vs. 92.5% (P<0.001) for cardiopulmonary resuscitation, 38.3% vs. 92.5% (P<0.001) for intubation and mechanical ventilation, 39.1% vs. 85.8% (P<0.001) for inotropics, 60.9% vs. 94.8% (P<0.001) for dialysis and 27.8% vs. 56.0% (P<0.001) for total parenteral nutrition). Significantly more students opposed euthanasia after the education (46.6% vs. 82.1%, P<0.001). All students agreed to the need for education in end-of-life care. Conclusion: After reflecting on the meaning of death through the end-of-life care education, most students recognized the need for the education. The education brought remarkable changes in students' awareness and attitude towards patients at the end of life. We suggest end-of-life care education should be included in the regular curriculum of all medical schools in Korea.

• Journal of fish pathology
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• v.18 no.3
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• pp.247-258
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• 2005

To understand responses of bivalve tissues to various injurious agents, histopathological observation was done in the Manila clam, Ruditapes hilippinarum, during 240 hours after an intramuscular injection of N-methyl-N-nitro-N-nitrosoguanidine (MNNG). Some histopathological changes were observed with the epithelia of stomach, midgut, hindgut, digestive diverticula and gonads after injecting MNNG. The earliest degenerative changes were recognized in the epithelium of midgut 12 hours after the injection. Partial or complete, epithelial destruction was constantly accompanied by the massive infiltration of a mononuclear, necrotic cell group including hemocytes. At 144 hours later, gonads showed the necrotic desquamation of their germinal epithelia. Nearly all of the infiltrated cells within the destructive epithelium were suggested to be hemocytes, from the binding property with a hemocyte-specific lectin, Ricinus communis (RCA-1). From these results it was concluded that the epithelium of digestive system is vulnerable to parenteral MNNG and hemocytes might be deeply involved in this MNNG-induced destruction of the digestive epithelium.

• Advances in pediatric surgery
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• v.14 no.1
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• pp.67-74
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• 2008

The usefulness of totally implantable central venous port for long-term intravenous infusion is widely accepted in children. Usually the catheters are placed through the internal or external jugular vein. In case of jugular vein cut-down, two separate incisions are needed for catheter and port respectively. Patients also feel uncomfortable as the catheter run through the neck. However these disadvantages can be overcome by using the cephalic vein (CV). We reviewed our experiences on CV cut-down for totally implantable central venous port in children. From January 2002 to December 2006, 201 patients (M:F=127:74) underwent 218 central venous port insertions. Mean age at operation was 5.9 years (2 months - 19 years). Indications included chemotherapy (N=167), long-term intravenous antibiotics infusion (N=36), and total parenteral nutrition (N=15). CV was selected preferentially. The incision includes the deltopectoral triangle laterally, and both the CV cut-down and port insertion were achieved with a single incision. The number of insertion through external, internal jugular vein, and CV was 77, 66 and 75, respectively. The median age, height and body weight were higher in CV cut-down group. The youngest age for CV cut-down was 8 months, the shortest height was 69 cm and the smallest body weight was 5.9 kg. Of 118 trials of CV cut-down, cut-down was successful in 75 cases (63.6 %). CV was absent in 10 cases(8.4 %) and CV was sacrificed after catheter tip malposition in 10 cases (8.4 %). There was only one complication, in which the catheter was inserted into the minute branch of subclavian artery. The CV cut-down method for totally implantable central venous port was safe and feasible in selected groups of patients in children. In addition, preservation of jugular vein and a more favorable cosmetic effect are other benefits of CV cut-down.

• Journal of the Korean Dietetic Association
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• v.15 no.4
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• pp.335-342
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• 2009

Forty-two percent of the patients with renal failure that requires continuous renal replacement therapy (CRRT) have been reported to have severe malnutrition, and preexisting malnutrition is a statistically significant and independent predictor of negative hospital outcomes. We performed this study to evaluate the appropriateness of the calorie and protein provided for the critically ill patients who require CRRT. One hundred forty-nine patients who received CRRT were enrolled. The demographic data, the length of the ICU stay and the mortality were recorded. The calorie/protein intake and the blood urea nitrogen (BUN), albumin and creatinine levels were used as nutritional parameters. The mean daily calorie intake during CRRT was 16.1${\pm}$7.4 kcal/kg, which was 64% of the recommended intake. Only 10% of the patients received the recommended caloric intake and the ratio of the enteral and parenteral calories was 26%/74%. The mean protein intake was 0.58${\pm}$0.34 g/kg, which was 38% of the recommended intake. The calorie and protein intakes at the termination of CRRT were significantly increased compared to the initial day of treatment, but they stayed under the recommended intake. The BUN, creatinine and albumin levels were significantly increased in the survival group (odds ratio for albumin: 2.73; creatinine: 2.43). A strategy to increase the nutrition provision is needed to improve the nutritional statuses and clinical outcomes of the critically ill patients who require CRRT.