Background: Vancomycin-resistant enterococci (VRE) infections have become a major healthcare-associated pathogen problem worldwide. Nosocomial VRE infections could be effectively controlled by screening patients at high risk of harboring VRE and thereby lowering the influx of VRE into healthcare centers. In this study, we evaluated factors associated with VRE colonization in patients transferred to emergency departments, to detect patients at risk for VRE carriage. Methods: This study was conducted in the emergency department of a medical college-affiliated hospital in Korea. Every patient transferred to the emergency department and admitted to the hospital from January to December 2016 was screened for VRE using rectal cultures. In this cross-sectional study, the dependent variable was VRE colonization and the independent variables were demographic and clinical factors of the patients and factors related to the transferring hospital. Patients were divided into two groups, VRE and non-VRE, and previously collected patient data were analyzed. Then we performed logistic regression analyses of characteristics that differed significantly between groups. Results: Out of 650 patients, 106 (16.3%) had positive VRE culture results. Significant variables in the logistic analysis were transfer from geriatric long-term care hospital (adjusted odds ration [aOR]: 8.017; 95% confidence interval [CI]: 1.378-46.651), hospital days (4-7 days; aOR: 7.246; 95% CI: 3.229-16.261), duration of antimicrobial exposure (1-3 days; aOR: 1.976; 95% CI: 1.137-3.436), and age (aOR: 1.025; 95% CI: 1.007-1.043). Conclusion: VRE colonization in patients transferred to the emergency department is associated primarily with factors related to the transferred hospitals rather than demographic and clinical characteristics.
Ursolic acid (UA), a type of pentacyclic triterpenoid carboxylic acid purified from natural plants, can promote skeletal muscle development. We measured the effect of resistance training (RT) with/without UA on skeletal muscle development and related factors in men. Sixteen healthy male participants (age, $29.37{\pm}5.14$ years; body mass index=$27.13{\pm}2.16kg/m^2$) were randomly assigned to RT (n=7) or RT with UA (RT+UA, n=9) groups. Both groups completed 8 weeks of intervention consisting of 5 sets of 26 exercises, with 10~15 repetitions at 60~80% of 1 repetition maximum and a 60~90-s rest interval between sets, performed 6 times/week. UA or placebo was orally ingested as 1 capsule 3 times/day for 8 weeks. The following factors were measured pre-and post-intervention: body composition, insulin, insulin-like growth factor-1 (IGF-1), irisin, and skeletal muscle strength. Body fat percentage was significantly decreased (p<0.001) in the RT+UA group, despite body weight, body mass index, lean body mass, glucose, and insulin levels remaining unchanged. IGF-1 and irisin were significantly increased compared with baseline levels in the RT+UA group (p<0.05). Maximal right and left extension (p<0.01), right flexion (p<0.05), and left flexion (p<0.001) were significantly increased compared with baseline levels in the RT+UA group. These findings suggest that UA-induced elevation of serum irisin may be useful as an agent for the enhancement of skeletal muscle strength during RT.
Backgrounds : The advent of penicillin has led to the marked reduction in the mortality from pneumococcal bacteremia, however, the mortality is still relatively high in this post-antibiotic era. Actually the prevalence of infection due to penicillin-resistant penumococci is increasing worldwide, and it is especially high in Korea due to irrelevant use of antibiotics. So, the high mortality of pneumococcal sepsis might be related to the emergence of penicillin-resistant strains, however, many other antibiotics, which eradicate pneumococci effectively, are available in these days. This has led us to suspect the role of penicillin-resistance in the high mortality rate. In this study, we evaluated the effect of penicillin resistance on the mortality of patients with penumococcal bacte remia. Methods: The study population consisted of 50 adult patients with penumococcal bacteremia who were admitted between Jan, 1990 and July, 1997. Medical records were analyzed retrospectively. Results: Most of the patients (96%) had underlying diseases. The most common local disease associated with pneumococcal bacteremia was pneumonia (42%), which was followed by spontaneous bacterial peritonitis (14%), cholangitis (10%), meningitis (8%), liver abscess (4%), pharyngotonsillitis (4%), sinusitis (2%) and cellulitis (2%). While the overall case-fatality rate in this study was 24%, it was higher when peumococcal bacteremia was associated with pneumonia (42%) or meningitis (50%). The rate of penicillin resistance was 40%, which was increased rapidly from 1991. The rate of penicillin resistance was significantly higher in patients with the history of recent antibiotics use and hospitalization within 3 months respectively. The clinical manifestations, that is, age, severity of underlying diseases, nosocomial infection, associated local diseases, and the presence of shock or acute renal failure were not statistically different between the patients with penicillin-resistant and -sensitive pneumococcal bacteremia. The mortality of patients infected with penicillin-resistant pneumococci was not statistically different from those with penicillin-sensitive pneumococcal bacteremia. Conclusion: Penicillin resistance is not associated with high mortality in adult patients with pneumococcal bacteremia. As the overall mortality is high, active penumococcal vaccination is recommended in patients with high risk of infection.
Park, Seung-Kyu;Choi, In-Hwan;Kim, Cheon-Tae;Song, Sun-Dae
Tuberculosis and Respiratory Diseases
/
v.44
no.6
/
pp.1234-1244
/
1997
Background : Nowadays drug resistant tuberculosis is making problems in the treatment of pulmonary tuberculosis and its number is increasing. Several reasons for this are considered including irregular medication, poor drug compliance and wrong regimens. But there are treatment failure cases in spite of regular medication with short-term standard regimens. We reviewed clinical data of 50 patients to find out possible causes of this. Method : Subject of this study was 50 patients who failed in the primary treatment of pulmonary tuberculosis in spite of regular medication with short-term standard regimens. All of them were under treatment with secondary regimens in National Masan Tuberculosis Hospital on Oct 1996. The patient's records were analyzed retrospectively and direct interviews with patients were done. Results : There were relatively more patients in the age of 20th. Male overwhelmed in number. There were smoking in 22 patients and drinking in 24 patients during medication. 17(34%) patients had family history of tuberculosis. Public health center was the most common site for the initial diagnosis among medical institutes. 42 patients had subjective symptoms for pulmonary tuberculosis. 38 patients got sufficient explanation from medical institute about tuberculosis and medication courses. 24 patients had bilateral lesions on chest X-ray film and 43 patients had cavitary lesions. 29 patients had past history for pulmonary tuberculosis with regular medication. The results of drug sensitivity test showed resistance in 41 patients of whom we could get the results. Conclusion : Main cause of treatment failure of pulmonary tuberculosis in spite of regular medication with short-term standard regimens was drug resistance. Several factors were considered to be related to high prevalence of drug resistance, including age of 20th, male, family history for tuberculosis, bilateral lesions or remaining cavitary lesion on chest X-ray film.
Introduction: REM sleep which shows characteristic muscle atonia and increased resistance of upper respiratory track is known to be vulnerable to sleep apnea. Previous studies reported that REM sleep-dependent (or related) obstructive sleep apnea syndrome (REM-dependent OSA) could be one of sleep disordered breathing. The present study aimed to investigate clinical findings and polysomnographic variables of REM-dependent OSA. Methods: Fifty-six patients diagnosed with mild to moderate obstructive sleep apnea by overnight polysomnography (5$53.7{\pm}16.7$ years, 42 males). REM-dependent OSA was defined as AHI-REM/AHI-NREM ratio>2. We compared clinical and polysomnographic findings between REM-dependent OSA and No REM-dependent OSA patients. Results: Among 56 patients, 37.5% (n=21, average age of $52.3{\pm}19.7$ years, 14 males) met the REM-dependent OSA criteria. There were no significant differences in age, sex and body mass index between two groups. After controlling for age, sex, body mass index and periodic leg movements index, REM-dependent OSA patients showed significantly lower AHI, lower number of oxygen desaturation events and higher stage 2 sleep proportion compared to No REM-dependent OSA patients (p=0.010, p=0.006, p=0.031, respectively). After controlling for age, sex, body mass index and periodic legs movements index, AHI-REM was positively correlated with the number of oxygen desaturation events in REM-dependent OSA group (p=0.002). Conclusion: Current results suggested that 37.5% of patients with mild to moderate severity of obstructive sleep apnea could be classified into REM-dependent OSA. REM-dependent OSA was more common in mild severity of OSA, equally prevalent in both sexes and accompanied with sleep architecture changes, i.e. increased proportion of stage 2. In addition, apneic events during REM sleep in REM-dependent OSA were related to oxygen desaturation.
Big data refers to the data that cannot be processes with conventional contemporary data technologies. As smart devices and social network services produces vast amount of data, big data attracts much attention from researchers. There are strong demands form governments and industries for bib data as it can create new values by drawing business insights from data. Since various new technologies to process big data introduced, academic communities also show much interest to the big data domain. A notable advance related to the big data technology has been in various fields. Big data technology makes it possible to access, collect, and save individual's personal data. These technologies enable the analysis of huge amounts of data with lower cost and less time, which is impossible to achieve with traditional methods. It even detects personal information that people do not want to open. Therefore, people using information technology such as the Internet or online services have some level of privacy concerns, and such feelings can hinder continued use of information systems. For example, SNS offers various benefits, but users are sometimes highly exposed to privacy intrusions because they write too much personal information on it. Even though users post their personal information on the Internet by themselves, the data sometimes is not under control of the users. Once the private data is posed on the Internet, it can be transferred to anywhere by a few clicks, and can be abused to create fake identity. In this way, privacy intrusion happens. This study aims to investigate how perceived personal information overload in SNS affects user's risk perception and information privacy concerns. Also, it examines the relationship between the concerns and user resistance behavior. A survey approach and structural equation modeling method are employed for data collection and analysis. This study contributes meaningful insights for academic researchers and policy makers who are planning to develop guidelines for privacy protection. The study shows that information overload on the social network services can bring the significant increase of users' perceived level of privacy risks. In turn, the perceived privacy risks leads to the increased level of privacy concerns. IF privacy concerns increase, it can affect users to from a negative or resistant attitude toward system use. The resistance attitude may lead users to discontinue the use of social network services. Furthermore, information overload is mediated by perceived risks to affect privacy concerns rather than has direct influence on perceived risk. It implies that resistance to the system use can be diminished by reducing perceived risks of users. Given that users' resistant behavior become salient when they have high privacy concerns, the measures to alleviate users' privacy concerns should be conceived. This study makes academic contribution of integrating traditional information overload theory and user resistance theory to investigate perceived privacy concerns in current IS contexts. There is little big data research which examined the technology with empirical and behavioral approach, as the research topic has just emerged. It also makes practical contributions. Information overload connects to the increased level of perceived privacy risks, and discontinued use of the information system. To keep users from departing the system, organizations should develop a system in which private data is controlled and managed with ease. This study suggests that actions to lower the level of perceived risks and privacy concerns should be taken for information systems continuance.
Objectives : Upper airway resistance syndrome(UARS) is a sleep-related breathing disorder characterized by abnormal negative intrathoracic pressure during sleep. Abnormally increased negative intrathoracic pressure results in microarousal and sleep fragmentation which underlay UARS-associated complaints of daytime fatigue and sleepiness. Although daytime dysfunction in patients with UARS is comparable to that of sleep apnea syndrome, UARS has been relatively unnoticed in clinical setting. That is why UARS is apt to be excluded in diagnosing of sleep-related breathing disorders since its respiratory disturbance index and arterial oxygen saturation are within normal limits. The current study presents a summary of clinical and polysomnographic characteristics found in patients with UARS. The present study aims (1) to explore characteristics of patients diagnosed with UARS, (2) to characterize the polysomnographic findings of UARS patients, and (3) to enhance the understanding of UARS through those clinical and laboratory characteristics. Methods : This was a retrospective study of 20 UARS patients (male 15, female 5) and 30 obstructive sleep apnea (OSA) patients (male 21, female 9) at the Stanford Sleep Disorders Clinic. We diagnosed patients as having UARS when they met critenia, RDI < 5 characteristic findings of an elevated esophageal pressure($<-10\;cmH_2O$), frequent arousals secondary to an elevated esophageal pressure, and symptoms of daytime fatigue and sleepiness. We used polysomnographic value, which is standardized by Williams et al(1974), as normal control. Statiotical test were done with student t-tests. Results : (1) Mean age of UARS was $41.0\;{\pm}\;14.8$ years and OSA was $50.9\;{\pm}\;12.0$ years. UARS subject was significantly younger than OSA subject (p<0.05). (2) The total score of Epworth Sleepiness Scale (ESS) was UARS $9.7\;{\pm}\;6.3$ and OSAS $11.2\;{\pm}\;6.3$. There was no significant difference between two groups. (3) The mean body mass index was UARS $28.1\;{\pm}\;5.7\;kg/m^2$ and OSAS $32.9\;{\pm}\;7.0\;kg/m^2$. UARS had significantly lower meen body man index than OSAS subjects (p<0.05). (4) The polysomnographic parameters of UARS were not significantly different from those of OSA except RDI(p<0.001), $SaO_2$ (p<0.001) and slow wave sleep latency (p<0.05). (5) Compared with normal control, Total sleep time in UARS subjects was significantly shorter (p<0.001), sleep efficiency index was significantly lower (p<0.001), total awakening percentage was significantly higher (p<0.001), and sleep stage 1 (p<0.001) were significantly higher. (6) OSA patients showed poor sleep quality and distinct abnormal sleep architectures compared with normal control. Conclusions : Conclusions from the above results are as follows : (1) UARS patients were younger and had lower body mass index when umpared with OSA patients. (2) The quality of sleep and sleep architectures of the UARS and OSA patients are significantly different from those of normal control. (3) ESS scores and awakening frequencies of UARS are similar with those of OSA, suggesting that daytime dysfunction of UARS patients may be comparable to those of OSA patients. (4) The RDI and the $SaO_2$ which are important indicators in diagnosing sleep-related breathing disorders, of UARS subjects are close to normal value. (5) According to the the above results, we unclude that despite the absence of $SaO_2$ drops and the absence of an elevated number of apnea and hypopnea, subjects developed clinical complaints which were associated with laborious breathing, elevated Pes nadir, and frequently snoring. (6) Accordingly, we suggest including LIARS in the differential diagnosis list when sleep related breathing disorder is suspected clinically and overnight polysomnographic findings except snoring and frequent microarousal are within normal limits.
Background: The complication rate of fungal disease is higher among patients with hematological malignancies. We investigated the clinicobacteriological outcomes of resected pulmonary fungal infections complicating hematological malignancies. Methods: Between 2001 and 2017, 21 patients with pulmonary fungal infections complicating hematological malignancies underwent resection, and their clinical records and survival were retrospectively reviewed. Results: The median age of the patients was 47 years, and 13 were male. The histological diagnoses were pulmonary aspergillosis (19 cases), mucormycosis (1 case), and cryptococcosis (1 case). The indications for surgery were resistance to antifungal therapy and the necessity of surgery before hematopoietic stem cell transplantation in 13 and 8 cases, respectively. The diagnoses of the hematological malignancies were acute myelogenous leukemia (10 cases), acute lymphocytic leukemia (5 cases), myelodysplastic syndrome (3 cases), and chronic myelogenous leukemia, malignant lymphoma, and extramedullary plasmacytoma (1 case each). The surgical procedures were partial resection (11 cases), segmentectomy (5 cases), lobectomy (4 cases), and cavernostomy (1 case). The size of the lesions was 0.9-8.5 cm. Fourteen cases had cavitation. There were no surgical-related deaths or fungal progression. Conclusion: Pulmonary fungal infections are resistant to treatments for hematological malignancies. Since the treatment of the underlying disease is extended and these infections often recur and are exacerbated, surgery should be considered when possible.
The objective of this study was to investigate the effects of dietary vitamin B intake on biomarkers related to lipid metabolism, inflammation and blood glucose control, that are important in the development of type 2 diabetes and its complications. Seventy-six adults (42 males, 34 females) were recruited from a group of diabetes patients who had visited the medical center for treatment. Data on anthropometric characteristics and dietary intake of thiamine, riboflavin, niacin, vitamin B6 and folate were collected using 24-hour diet recall and the CAN Pro 4.0 program. Also, data on clinical indices such as serum lipids, blood pressure, high-sensitivity C-reactive protein (hs-CRP), hemoglobin A1c (HbA1c) and homeostasis model assessment 2-insulin resistance (HOMA2-IR) were collected and analyzed for correlation with dietary vitamin B intake. Results from the dietary intake survey showed that riboflavin and folate intake (in males) and folate intake (in females) were below the Dietary Reference Intake for Koreans. Statistical analysis revealed a negative correlation between hs-CRP and dietary intake of B vitamins. Riboflavin intake was inversely associated with systolic blood pressure after adjustments for age, BMI, smoking, alcohol consumption, exercise, ingestion of diabetes mellitus medication and energy intake (p<0.05). Our results suggest that dietary vitamin B may influence inflammation and consequently may help in better management of type 2 diabetes.
The protecting-chamber for a standing Buddha of Mireuk-ri temple site at Jungwon is composed of granite of Cretaceous age which mainly consists of quartz, perthite, plagioclase, and biotite with minor amounts of muscovite, apatite, chlorite, sericite and opaque mineral. There are abundant cracks which may be developed by strong weathering and differential loading by structural unbalances of the whole protecting-chamber. Cracks can be divided into three types based on genesis as those formed by exfoliation, intrinsic, and pressure. The exfoliation occurred along the onion structure of the granite. The pressure cracks are generally superimposed on the exfoliation ones, which might be developed by structural unbalance of the protecting-chamber resulted from differential loading in places. The structural unbalance may be due to change in physical properties of the rocks according to strong weathering, differential settling of basement soil by difference in loading in places of protecting-chamber, westward creep of the basement soil below the West wall and related different resistance of the basement soil against the loading, and partial depression of the West wall. For the conservation of the protecting-chamber, it must be considered the method of stabilizing the basement and treatment of the cracks.
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