• The Korean journal of internal medicine
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• v.39 no.3
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• pp.448-457
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• 2024

Background/Aims: Improved knowledge of local epidemiology and predicting risk factors of multidrug-resistant (MDR) bacteria are required to optimize the management of infections. This study examined local epidemiology and antibiotic resistance patterns of liver cirrhosis (LC) patients and evaluated the predictors of MDR bacteremia in Korea. Methods: This was a retrospective study including 140 LC patients diagnosed with bacteremia between January 2017 and December 2022. Local epidemiology and antibiotic resistance patterns and the determinants of MDR bacteremia were analyzed using logistic regression analysis. Results: The most frequently isolated bacteria, from the bloodstream, were Escherichia coli (n = 45, 31.7%) and Klebsiella spp. (n = 35, 24.6%). Thirty-four isolates (23.9%) were MDR, and extended-spectrum beta-lactamase E. coli (52.9%) and methicillin-resistant Staphylococcus aureus (17.6%) were the most commonly isolated MDR bacteria. When Enterococcus spp. were cultured, the majority were MDR (MDR 83.3% vs. 16.7%, p = 0.003), particularly vancomycin-susceptible Enterococcus faecium. Antibiotics administration within 30 days and/or nosocomial infection was a significant predictor of MDR bacteremia (OR: 3.40, 95% CI: 1.24-9.27, p = 0.02). MDR bacteremia was not predicted by sepsis predictors, such as positive systemic inflammatory response syndrome (SIRS) or quick Sequential Organ Failure Assessment (qSOFA). Conclusions: More than 70% of strains that can be treated with a third-generation cephalosporin have been cultured. In cirrhotic patients, antibiotic administration within 30 days and/or nosocomial infection are predictors of MDR bacteremia; therefore, empirical administration of broad-spectrum antibiotics should be considered when these risk factors are present.

• Tuberculosis and Respiratory Diseases
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• v.67 no.1
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• pp.21-26
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• 2009

Background: Non-invasive positive pressure ventilation (NPPV) ensures adequate gas exchange during bronchoscopy in spontaneously breathing, hypoxemic patients, thus avoiding endotracheal intubation. However, in some patients, endotracheal intubation is eventually required after bronchoscopy. This study investigated the incidence of intubation and predictors of a need for emergency intubation prior to NPPV bronchoscopy initiation. Methods: On a retrospective basis, we reviewed the medical records of 36 patients (median age, 55 years; interquartile range [IQR], 43~65 years) with acute hypoxemic respiratory failure who required NPPV during bronchoscopy between January 2005 and October 2007. Results: All patients were hypoxemic (median $PaO_2/FiO_2$ ratio 155; IQR 90~190), but tolerated bronchoscopy with NPPV support. SOFA score and SAPS II score immediately before NPPV initiation were 4 (3~7) and 36 (30~42), respectively. Seventeen (47%) patients needed endotracheal intubation at a median time of 22 (2~50) hours after bronchoscopy. Patients who needed intubation after bronchoscopy had a higher in-hospital mortality (11 [65%] vs. 4 [21%], p=0.017). Upon multiple logistic regression analysis, the need for intubation after bronchoscopy was independently associated with a $P_aO_2/FiO_2$ ratio (OR, 0.961; 95% CI, 0.924~0.999; p=0.047) immediately before NPPV initiation for bronchoscopy. Conclusion: The severity of the hypoxemia immediately prior to NPPV initiation for bronchoscopy was associated with the need for intubation after bronchoscopy in patients with hypoxemic respiratory failure.

• Tuberculosis and Respiratory Diseases
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• v.60 no.4
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• pp.419-425
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• 2006

Background : Severe community-acquired pneumonia (CAP) can develop into respiratory failure that requires mechanical ventilation (MV), which is associated with a higher rate of mortality. It was recently reported that a hydrocortisone infusion in severe CAP patients was associated with a significant reduction in the length of the hospital stay and mortality. This study evaluated efficacy of a hydrocortisone infusion for patients with severe CAP requiring MV. Methods : From February 2005 to July 2005, 13 patients (M : F = 10 : 3, mean age: $68.6{\pm}14.1years$), who were diagnosed with severe CAP and required MV, were enrolled in this study. Hydrocortisone was administered as an intravenous 200mg loading bolus, which was followed by an infusion at a rate of 10mg/hour for 7 days. The control group was comprised of patients with severe CAP requiring MV but in whom corticosteroid was not used before study period. The clinical and physiologic parameters on or by day 8 and the outcome in the hydrocortisone infusion group were compared with those in the control group. Results : 1) There was no significant difference in age, gender ratio, SAPS II, SOFA score, temperature, leukocyte count, PaO2/FiO2 (P/F) ratio, the number of patients with P/F ratio < 200, chest radiograph score, lung injury score and catecholamine-dependent septic shock between the hydrocortisone infusion group and control group at day 1. 2) At day 8, the proportion of patients with an improvement in the P/F ratio ${\geq}100$ and the chest radiograph score was significantly higher in the hydrocortisone infusion group than in the control group (61.5% vs. 15.4%, 76.9% vs. 23.1%, p< 0.05). However, there was no significant difference in the other clinical and physiologic parameters. 3). There was no significant difference in the duration of the MV, ICU stay, hospital stay and 10th and 30th day mortality between the two groups. Conclusion : Hydrocortisone infusion for patients with severe CAP requiring invasive mechanical ventilation may be effective in improving the level of oxygenation and the chest radiograph score.

• Tuberculosis and Respiratory Diseases
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• v.59 no.5
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• pp.487-496
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• 2005

Background : 'Major pulmonary thromboembolism' is defined as right ventricular (RV) dysfunction, with or without shock, accompanied by significant morbidity and mortality. In this study, those with major pulmonary thromboembolism were divided into the shock and RV dysfunction only groups, and then investigated the mortality and complications in thrombolysis or anticoagulation, respectively. Methods : In a retrospective study, between January 1995 and December 2004, 60 eligible patients with a major pulmonary thromboembolism, admitted in Asan Medical Center, were included. Results : A total of 57 patients were treated with medical therapy. Thrombolysis was performed in 13 patients (23%) and anticoagulation in 44 (77%). There were no differences in the APACHEII and SOFA scores between the two groups. 6 (46%) and 11 (25%) patients died in the thrombolysis and anticoagulation groups, respectively (p=0.176). In the 19 patients (33%) showing shock, thrombolysis was performed in 9 (47%) and anticoagulation in 10 (53%). 4 (44%) of the 9 patients treated with thrombolytic agents and 3 (30%) of the 10 treated with anticoagulants died (p=0.650). In the 38 patients (67%) showing RV dysfunction only, thrombolysis was performed in 4 (11%) and anticoagulation in 34 (89%). 2 (50%) of the 4 patients treated with thrombolytics and 8 (24%) of the 34 treated with anticoagulants died (p=0.279). Three patients (23%) who underwent thrombolysis had a major bleeding episode, compared with 2 (5%) who were treated with anticoagulants (p=0.072). Conclusion: The results of our study showed that thrombolysis did not lower mortality and tended to increase major bleeding compared with anticoagulation in both the shock and RV dysfunction only groups. Further evaluation of the efficacy and safety of thrombolytic therapy for major thromboembolism appears warranted in Korea.

• Tuberculosis and Respiratory Diseases
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• v.58 no.6
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• pp.562-569
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• 2005

Background : The severity scoring system is useful for predicting the outcome of critically ill patients. However, the system is quite complicated and cost-ineffective. Simple serologic markers have been proposed to predict the outcome, which include troponin-I, lactate and C-reactive protein(CRP). The aim of this study was to evaluate the prognostic values of troponin-I, lactate and CRP in critically ill non-cardiac patients. Methods : From September 2003 to June 2004, 139 patients(Age: $63.3{\pm}14.7$, M:F = 88:51), who were admitted to the MICU with non-cardiac critical illness at Gyeongsang National University Hospital, were enrolled in this study. This study evaluated the severity of the illness and the multi-organ failure score (Acute Physiologic and Chronic Health EvaluationII, Simplified Acute Physiologic ScoreII and Sequential Organ Failure Assessment) and measured the troponin-I, lactate and CRP within 24 hours after admission in the MICU. Each value in the survivors and non-survivors was compared at the 10th and 30th day after ICU admission. The mortality rate was compared at 10th and 30th day in normal and abnormal group. In addition, the correlations between each value and the severity score were assessed. Results : There were significantly higher troponin-I and CRP levels, not lactate, in the non-survivors than in the survivors at 10th day($1.018{\pm}2.58ng/ml$, $98.48{\pm}69.24mg/L$ vs. $4.208{\pm}10.23ng/ml$, $137.69{\pm}70.18mg/L$) (p<0.05). There were significantly higher troponin-I, lactate and CRP levels in the non-survivors than in the survivors on the 30th day ($0.99{\pm}2.66ng/ml$, $8.02{\pm}9.54ng/dl$, $96.87{\pm}68.83mg/L$ vs. $3.36{\pm}8.74ng/ml$, $15.42{\pm}20.57ng/dl$, $131.28{\pm}71.23mg/L$) (p<0.05). The mortality rate was significantly higher in the abnormal group of troponin-I, lactate and CRP than in the normal group of troponin-I, lactate and CRP at 10th day(28.1%, 31.6%, 18.9% vs. 11.0%, 15.8 %, 0%) and 30th day(38.6%, 47.4%, 25.8% vs. 15.9%, 21.7%, 14.3%) (p<0.05). Troponin-I and lactate were significantly correlated with the SAPS II score($r^2=0.254$, 0.365, p<0.05). Conclusion : Measuring the troponin-I, lactate and CRP levels upon admission may be useful for predicting the outcome of critically ill non-cardiac patients.

• Science of Emotion and Sensibility
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• v.14 no.3
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• pp.395-402
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• 2011

As the consumer market for odor products grows, companies producing healthcare products are beginning to pay more attention to the emotional aspect of an odor product in order to differentiate their products from competitors. In the following research, the affective effect of odor product was investigated while focusing on relaxation and working contexts using orange and pine scents, since these are typical odors in current domestic market. Two empirical studies were carried out. First, in experiment I, 18 subjects, all of whom were university students, spent 20 minutes sitting comfortably on a sofa while electrocardiogram assessments were made. After a five-minute break, in experiment II, the same subjects were provided with both arithmetic and geometric questions and their electroencephalogram readings was recorded from eight channels. All subjects participated in three sessions - no odor, an orange scent, and then a pine scent - with a minimum time interval of 24 hours. The results show that in the context of a pine scent, both the activation ratio of subjects' parasympathetic system and those of the Sensory Motor Rhythm waves and Mid Beta waves were at the highest peak. Therefore, the pine scent helped the subjects to feel more comfortable and more focused at the same time. In other words, it gave them a state of meditated attention. In addition, it was found that the right brain was activated twice the intensity when the subjects worked through the geometric questions, whereas both sides of the brain were activated in equal magnitude during the process of arithmetic tasks. This replicates previous studies of the functional aspect of the right brain - being responsible for spatial and creative thinking.

• The Journal of the Korea Contents Association
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• v.14 no.2
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• pp.430-441
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• 2014

The present study is a descriptive survey to examine the knowledge of and attitudes towards musculoskeletal disorders and the bad postural habits in nursing students and to determine the relationships between the both sides. This study was performed using a structured questionnaire from September 2 through 17, 2013. The questionnaire copies collected from 272 nursing students were analyzed using t-test, one-way ANOVA, Pearson's correlation coefficient. The following are the results: First, the subjects won 2.75, 3.24 and 3.21 among 1 to 5 points in the knowledge of musculoskeletal disorders, the attitudes towards musculoskeletal disorders and the bad postural habits. Among the bad postural habits, they earned higher points in the postures of lying on the back in a sofa, carrying a bag on the shoulder and sitting with legs crossed. Second, significant negative correlations with the knowledge of and attitudes towards musculoskeletal disorders were shown only by the postures of sleeping lying on the side, lifting things with the waist bent at and sitting with hips placed on and no back attached to a chair. The results of this study are expected to be used as basic data to enhance the awareness that nursing students should correct their bad postural habits and to strengthen the knowledge of and attitudes towards musculoskeletal disorders at the time of developing any musculoskeletal health improvement program for nursing students.

• Fire Science and Engineering
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• v.31 no.2
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• pp.29-36
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• 2017

The design fire based on the heat release rate (HRR) of combustibles can significantly affect the assessment of fire safety in the performance-based design (PBD). In the present PBD, however, limited information in the foreign literature has been used without further verification due to the lack of fire information in domestic combustibles. The objective of this study is to provide information on the HRR and fire growth rate for various combustibles in residential and office spaces. To end this, the fire experiments were carried out with single and multiple combustibles. The peak HRR of combustibles used in the present study had a range of 36 kW~1,092 kW. The fire growth rates were also $0.003kW/s^2{\sim}0.0287kW/s^2$ and $0.003kW/s^2{\sim}0.0838kW/s^2$ for the residential and office spaces, respectively. In particular, a sofa had the highest fire risk in terms of the peak HRR and fire growth rate. Finally, a methodology for calculating the peak HRR in a space was proposed through correlation analysis between the peak HRR and exposed surface of various combustibles.

• Fire Science and Engineering
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• v.21 no.3
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• pp.15-23
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• 2007

In the events of a fire in the residential building, highly flammable polyurethane foam sofa produce toxic smokes. In this type of fire, the residents of the building can be gotten into the difficulties of evacuating from the fire places or may be to death due to a lot of hot toxic gases. In this study, CFD simulations were carried out to study the effects of the openings of stairwell on the fire characteristics of fire room and stairwell. Also, analysis of fire hazard based on the tenability limits of fire and FED(fractional effective dose) was performed to evaluate the life safety of the residents of the building. In the fire room, maximum temperature was about $290^{\circ}C$, maximum CO concentration was about 4,740 ppm, and the time to incapacitation of residents in fire room was about t=144 s. In the stairwell, temperature and CO concentration in the condition of openings to be open were even lower than those in it to be closed. Time to the tenability limit with respect to smoke visibility in the stairwell with openings, which was open, was shorter than that of it without openings to be open. It has been shown from this study that opening the stairwell openings is able to decrease the fire hazards to the life safety in the multi-story residential building fire.

• Journal of the Korean association of regional geographers
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• v.9 no.3
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• pp.297-313
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• 2003

Problems caused by the U.S. military bases have attracted little attention until recently due to the national security of S.Korea and the peace of North-Eastern Asia, emphasized from the perspective of macro-geopolitics. However, since the political regime has been democratized and political discourses have been liberalized from the 1990s, those problems become a nation-widely serious social issue, though they have been brought about on the local areas. Thus, it can be suggested that micro-geopolitics is highly relevant and significant in approaching the local problems caused by the U.S. military bases, and ultimately resolving the macro-geopolitical problem of longstanding unfair relations in the SOFA and the withdrawal of U.S. troops. This paper aims to consider local problems caused by the U.S. military bases and resolving strategies from the perspective of micro-geopolitics. First of all, it discusses some significance of the micro-geopolitical perspective, as it has been recently emphasized in political geography in considering local problems and politics of life on the basis of place, then looks on empirically criminal and environmental problems caused by the U.S. military bases, analyses the questionnaire date on the perception of local dwellers around the military camps in Nam-gu Daegu, and finally suggests strategies to resolve those problems, which level up from the micro to the macro-scale of geopolitics.