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BackgroundFree tissue transfer to the knee region in patients with chronic post-traumatic knee osteomyelitis (CTKOM) poses a great challenge to surgeons because the remaining soft tissues adjacent to defects, including vascular structures, are usually damaged by chronic inflammation and multiple debridements. Thus, we developed an algorithm to help select the optimal recipient vessels and appropriate anterolateral thigh perforator (ALTP) flap type. In addition, we performed surgery using this algorithm and achieved successful reconstructions. This study aims to review our experiences in algorithmic reconstruction and assess its efficacy.MethodsAccording to the defect size and location, our algorithm suggested the use of various-shaped ALTP flaps with centrally located perforators (Cen-ALTP flap) or eccentrically located perforators (Ecc-ALTP flap). Besides, through the algorithm, one recipient vessel was selected among three candidates, including descending branch of the lateral circumflex femoral artery (DB-LCFA), anterior tibial artery (ATA), and posterior tibial artery (PTA). Based on this algorithmic decision, we performed individualized soft tissue reconstructions of the knee in 21 patients with CTKOM, between March 2013 and June 2021. The medical records of the patients were retrospectively reviewed.ResultsThe Cen-ALTP flap (n = 15) and ATA (n = 9) were the most commonly used for reconstruction. The Cen-ALTP flap anastomosed to the ATA was most commonly selected (n = 7) using the algorithm, followed by the Cen-ALTP flap anastomosed to the DB-LCFA (n = 5), and the Cen-ALTP flap anastomosed to the PTA (n = 3). All transferred ALTP flaps survived the follow-up period. Postoperative venous congestion in two patients and hematoma in one patient were resolved by immediate treatment. The postoperative course was uneventful.ConclusionDuring free ALTP flap transfer to CTKOM-related knee defects, we could select the optimal recipient vessel and appropriate flap type using our algorithm and obtain excellent reconstructive outcomes. Therefore, we believe that our algorithm could provide helpful guidance to reconstructive surgeons on free ALTP flap transfer to reconstruct CTKOM-related soft tissue defects.

Invasive pneumococcal disease (IPD) is associated with substantial morbidity and mortality in children and elderly populations. Serotype distribution and antibiotic susceptibility of IPD isolates are changing with the implementation of pneumococcal vaccination and increasing antibiotic use worldwide. We aimed to determine serotype distribution, antibiogram, and molecular epidemiology of pneumococci in the late stage of PCV13 era.Prospective multicenter IPD surveillance study was conducted for adults aged ≥ 19 years from July 2019 to June 2021. Clinical and epidemiologic data were collected. In addition, antibiotic susceptibility test, serotype identification and multi-locus sequence typing (MLST) was taken for pneumococcal isolates.A total of 160 IPD cases were collected with mean age of 65.1 years (male, 72.5%). Serotyping was taken for 116 available pneumococcal isolates. PCV13 and PPSV23 serotypes were 32.8% (n = 38) and 56.0% (n = 65), respectively. Serotype 3 (13.8%) and 19A (9.5%) were the most common causative agents of IPD, followed by serogroup 11 (6.9%), 23A (6.9%), 10A (4.3%), and 15B (4.3%). Notably, 32.5% of invasive pneumococcal isolates were non-susceptible to ceftriaxone. Serotypes 11A, 11E and 19A pneumococci showed high ceftriaxone non-susceptible rate (80%, 100% and 81.8% respectively), and they were related to sequence type (ST) 166 and ST320. In comparison, most serotype 3 isolates were ceftriaxone susceptible and related to ST180.PCV serotypes, especially 3 and 19A, are still prevalent in adult IPDs, suggesting that individual PCV13 immunization would be necessary for the elderly people and chronically ill patients. Ceftriaxone non-susceptible rate was remarkably high in invasive pneumococcal isolates.

Partially purified ginsenoside extract (PGE) and compound K enriched extract (CKE) were prepared from ginseng sprouts, and their antioxidant, anti-inflammatory and antithrombotic effects were investigated. Compared to the 6-year-old ginseng roots, ginseng sprouts were found to have a higher content of phenolic compounds, saponin and protopanaxadiol-type ginsenoside by about 56%, 36% and 43%, respectively. PGE was prepared using a macroporous adsorption resin, and compound K(CK) was converted and enriched from the PGE by enzymatic hydrolysis with a conversion rate of 75%. PGE showed higher effects than CKE on radical scavenging activity in antioxidant assays. On the other hand, CKE reduced nitric oxide levels more effectively than PGE in RAW 264.7 cells. CKE also reduced pro-inflammatory cytokines, such as tumor necrosis factor-α, interleukin (IL)-1β and IL-6 than PGE. Tail bleeding time and volume were investigated after administration of CKE at 70–150 mg/kg/day to mice. CKE administered group showed a significant increase or increased tendency in bleeding time than the control group. Bleeding volume in the CKE group increased than the control group, but not as much as in the aspirin group. In conclusion, ginseng sprouts could be an efficient source of ginsenoside, and CKE converted from the ginsenosides showed antioxidant, anti-inflammatory and antithrombotic effects. However, it was estimated that the CKE might play an essential role in anti-inflammatory effects rather than antioxidant effects.

Objectives: This study aimed to characterize the risk factors for mortality in adult patients with invasive pneumococcal disease (IPD) stratified by age groups, after implementation of the national immunization program of 23-valent polysaccharide vaccine (PPSV23) for those aged ≥65 years in the Republic of Korea (ROK). Methods: Clinical data and pneumococcal isolates from adult patients with IPD (≥18 years of age) were collected prospectively from 20 hospitals through the nationwide surveillance program from March 2013 to October 2015. Results: A total of 319 patients with IPD were enrolled. Median age was 69 years. Overall in-hospital mortality was 34.2%: 17.1% in those aged 18–49 years, 23.7% in those aged 50–64 years, 33.0% in those aged 65–74 years, and 51.0% in those aged ≥75 years (p

Purpose: This study was done to develop competencies and core curriculum for gerontological nursing education in programs towards a Bachelor of Science in Nursing (BSN). Methods: From June 2015 to January 2016, competencies and core curriculum from gerontological nursing education in foreign countries were analyzed using a literature review, along with an analysis of the current gerontological nursing curriculum in Korean BSN programs. Competencies and core curriculum of undergraduate nursing education for gerontological nursing were determined through expert panel discussions in the Korean Gerontological Nursing Society. Results: Data were collected from 30 BSN programs in Seoul, Kyunggido, Kangwondo, Chungchungdo, Kyungsangdo, and Jeollado. Compared with the core curriculum for gerontological nursing recommended by the National Gerontological Nursing Association, there were deficiencies in legal/ethical issues, administrative issues, nursing research in gerontological nursing, and care and service delivery. From the data and panel discussion, 13 competencies and core curriculum including 6 contents, 32 programs, and 197 learning objectives were found to be important. Conclusion: Use of the recommended curriculum from this study can address deficiencies in baccalaureate gerontological nursing education, but it is also necessary to develop textbooks based on the recommended 13 competencies and core curriculum including 6 contents, 32 programs, and 197 learning objectives.

The purpose of this study is to identify the indicators needed to analyze the competitiveness of major countries’ energy technologies and to conduct empirical analysis accordingly. In this paper, nine measurement variables were derived as an index centered on patents and papers for energy technology competitiveness analysis. For each of the nine set measurement variables, the index for each of the major energy technologies (photovoltaics, fuel cells, and secondary batteries) was calculated, compared, and analyzed for each of the eight major countries.

Although pneumonia is the hallmark of Mycoplasma pneumoniae infections, it has been associated with protean manifestations such as extrapulmonary involvement. Herein, a rare case of mononuclear syndrome with acute hepatitis and erythema multiforme revealed as M pneumoniae infection without lung involvement is reported. A 30-year-old man, previously healthy, presented with fever and rash with acute hepatitis: AST 603 IU/L, ALT 747 IU/L, prothrombin time 52%. Peripheral blood smears indicated monocytosis with atypical lymphocyte. Bone marrow biopsy revealed increased plasma cell infiltration. M pneumoniae infection was detected by serology testing. After treatment with macrolide, clinical symptoms and signs and serological tests were fully resolved. Diagnosis of this etiologic association is important when patients present with various clinical syndromes without pneumonia, because only specific antimicrobial therapy is effective against M pneumoniae.

Due to the tragic disaster that happened in Japan and crippled the Fukushima nuclear power plant, serious concerns have been raised regarding the contamination of drinking water as a result of the radioactive materials that were released. Even though the quantities of radioactive material in rain were relatively low, people were concerned about the drinking water. Therefore, there is a need to know the removal efficiency of the unit process of water treatment and to prepare a safety plan to protect the public's health from radioactive materials. In this study, the laboratory scale removal rates were estimated for the coagulation/flocculation, adsorption, and ion exchange processes. The reference standard materials which are stable elements, Cesium-133 (Cs-133) and Iodine-127 (I-127), were used for the typical and advanced water treatment processes at the laboratory scale. For the coagulation/flocculation process, three major coagulants were assessed for this process. However, the removal rates of this process were low. For the adsorption process, powdered activated carbon and zeolites were investigated. The powdered activated carbon showed insignificant removal rates for both reference materials. However, synthetic zeolite was an effective process for Cs-133, and the ion exchange method showed high removal rates for both Cs-133 and I-127.

Three hundred and thirty-nine water samples obtained from 90 locations in Korea from 2007 to 2011 were tested for the presence of enteric viruses (EV), total coliforms (TC), and fecal coliforms (FC). A total culturable virus assay revealed that 89 samples (26.3%) were positive for EVs, the average concentration being 5.8 most probable number (MPN)/100 L. The Han river basin exhibited the highest contamination by EVs (occurrence, 41.3%; average concentration, 24.0 MPN/100 L). EV contamination was found more frequently in river water (occurrence, 33.6%; concentration, 8.4 MPN/100 L) than in lake water or groundwater. The concentration of EVs was highest in spring (7.7 MPN/100 L), whereas it was found most frequently in winter (36.1%). The number of TCs ranged from 0 – 1.2 × 105 colony forming units (CFU)/100 mL and that of FCs from 0–6.2 × 103 CFU/100 mL per sample. Statistical analyses showed that the presence of EVs, TCs and FCs did not correlate significantly with temperature or turbidity. In addition, presence of TCs and FCs was not significantly correlated with presence of EVs. In conclusion, TCs and FCs may not be accurate microbial indicators of waterborne EVs in Korean aquatic environments.

Background Pneumococcal meningitis (PM) is one of invasive pneumococcal disease (IPD) and is considered as a medical emergency with notable morbidity and mortality. This study was designed to characterize differences in clinical characteristics and outcomes, pneumococcal serotypes, and antimicrobial susceptibilities between PM and pneumococcal bacteremic pneumonia (PBP) in adult patients in the Republic of Korea (ROK) from a prospective observational cohort. Methods Adult IPD cases (≥18 years) were prospectively collected from 20 hospitals participated in the pneumococcal surveillance program in the ROK from 2013 through 2015. Serotyping and antimicrobial susceptibility testing were performed by a multiplexed serotyping assay and Microscan system, respectively. Results During the study period, 30 cases of PM and 205 cases of PBP were compared. Serotypes 19A, 15B/15C, and 35B were the most prevalent among PM cases, whereas serotypes 3, 11A/D/F, and 19A were the most common serotypes in PBP. There were significant female predominance (46.7% vs. 2.3%, P = 0.022), younger age (56.7% vs. 36.1%, P = 0.031), less immunocompromised states (3.3% vs. 28.8%, P = 0.005), less underlying chronic lung diseases (3.3% vs. 16.6%, P = 0.04), and lower mortality rate (16.7% vs. 44.4%, P = 0.004) in PM, compared with PBP. However, PM cases showed higher penicillin resistance (76.7% vs. 19.2%, P < 0.001), and ceftriaxone resistance (53.3% vs. 13.4%, P < 0.001), consistent with higher MDR prevalence in PM cases (76.7% vs. 53.2 P = 0.016). All PM cases except for three cases received empiric or definite vancomycin treatment. Multiple logistic regression analysis showed that penicillin resistance (odds ratio [OR] 15.75, 95% confidence interval (CI) 3.82–64.72, P < 0.001) and survival (OR 20.73, 95% CI 3.1–136.74, P = 0.002) were significantly associated with PM. Conclusion This study indicates that adult PM showed favorable clinical outcomes, compared with PBP, despite of differences in clinical characteristics. Disclosures All authors: No reported disclosures.

The effect of an isovalent chemical variation in A site cations on the stability of ferroelectric order and consequent changes in the electrical properties of ferroelectric 0.93( Bi 1/2 Na 1/2) TiO 3-0.05 BaTiO 3-0.02( K 0.5 Na 0.5) NbO 3 (0.93 BNT -0.05 BT -0.02 KNN ) lead-free piezoceramic at the morphotropic phase boundary (MPB) was investigated by substituting K for Na . X-ray diffraction analysis reveals that all the studied compositions undergo an irreversible phase transition from a pseudocubic to a mixture of rhombohedral and tetragonal phases during poling. In spite of the absence of an obvious structural difference, both electric-field-induced strain and polarization hysteresis loops show a clear distinction. It was found that the effect of substitution is so drastic that about 0.5 at% substitution renders the material softer and more than 1.0 at% results in a significant destabilization of the ferroelectric order. However, no notable difference in the temperature dependent permittivity measurements was detected, which suggests that the depoling of these materials has some other origin than a symmetry-breaking phase transition.

Summary Background Apoptosis is thought to play an important role in the development of acute respiratory distress syndrome (ARDS). We evaluated the bronchoalveolar lavage (BAL) fluid from ARDS patients focusing on apoptosis. Methods The study enrolled 31 ARDS patients and 20 healthy controls. BAL fluid levels of caspase-cleaved cytokeratin-18 (CK-18) and soluble mediators such as interleukin-8 (IL-8), soluble Fas (sFas), soluble Fas ligand (sFasL), growth-related oncogene-α (GRO-α), granulocyte colony-stimulating factor (G-CSF), and tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) were measured using enzyme-linked immunosorbent assay (ELISA). Results The BAL fluid caspase-cleaved CK-18 levels in ARDS patients were higher than those in controls, reflecting increased epithelial apoptosis, and were correlated with lung injury scores ( r s =0.49). The BAL fluid levels of all mediators were significantly higher in ARDS patients than in controls. In ARDS patients, the BAL fluid IL-8 level was positively correlated with the levels of sFas ( r s =0.57), GRO-α ( r s =0.47), and TRAIL ( r s =0.45). The BAL fluid IL-8 ( r s =0.61), sFas ( r s =0.57), G-CSF ( r s =0.44), and TRAIL ( r s =0.33) levels were correlated with the BAL fluid neutrophil count. The G-CSF levels were significantly higher in non-surviving than in surviving ARDS patients [median 183.4pg/mL (interquartile range 76.7–315.9) vs. 63.8pg/mL (36.2–137.2); p P aO 2 / F iO 2 ratio ( r s =0.40), and the TRAIL levels were negatively correlated with the multiple organ dysfunction scores ( r s =−0.37). Conclusions Among the mediators in BAL fluid from ARDS patients, G-CSF had the most significant prognostic implications, and the sFas and TRAIL levels were correlated with clinical severity.

A thermal diffusivity map for diamond wafers of 10-cm diameter was obtained using a converging thermal wave technique in a nondestructive and noncontact manner. Diamond wafers were deposited by seven-cathode dc plasma-assisted chemical vapor deposition with different CH4concentrations in pure hydrogen and applied powers of the plasma. Six cathodes were located at the apexes of a hexagon with an arm distance of 4.3 cm about a central cathode. The wafer deposited at a low-power plasma (13.47 kW) and a low concentration of CH4(6%, by volume) shows three circular zones on the thermal diffusivity map. The thermal diffusivity shows the lowest value at the center. It increases to about 10% in a radius of 2 to 3 cm and then decreases with further increases in the radius. The optical photograph and the Raman lines of the wafer show patterns similar to those of the thermal diffusivity. These are affected by the locations of the cathodes in the deposition chamber when the plasma power is low. Diamond wafers deposited at a high-power plasma (20.58 kW) with high concentrations of methane (10%, by volume) show higher values of thermal diffusivity and better uniformity than wafers deposited at a low power and low methane concentration. A fine crack can be located on a wafer with the converging thermal wave technique.

The measurement of thermal diffusivity for thin slabs by a converging thermal wave technique has been studied. Temperature variation at the center of the heat source ring that is produced by a pulsed high-power laser is detected by an infrared detector. A computer program based on the finite difference method is developed to analyze the thermal diffusivity of the slabs. Materials of both high thermal diffusivity (CVD diamond wafer) and low thermal diffusivity (stainless-steel foil) have been used for the measurements. The measurements have been performed by varying the size and the thickness of specimen. The converging thermal wave technique has proved to be a good method to measure the thermal diffusivity of a CVD diamond without breaking the wafer into small specimens. The technique can be applied for a small slab if the diameter of the slab is two times larger than that of the heat source ring. The sensitivity of thickness in measuring the thermal diffusivity is low for ordinary CVD diamond. The use of the converging thermal wave technique for nonhomogeneous, nonuniform, and anisotropic materials has been accomplished by applying the finite difference method.

Free-standing diamond wafers, 100 mm in diameter, have been deposited by the multi-cathode (seven-cathode) direct-current (DC) plasma-assisted chemical vapor deposition (PACVD) method. The input power was 17.5 kW and the pressure was 100 torr. The methane concentration in hydrogen was between 3.5% and 8% at a constant flow rate of 150 sccm. Intrinsic tensile stress was controlled by introducing thermal compressive stress with step-down control of the deposition temperature during diamond deposition. A higher growth rate of 10 μm h −1 was obtained by raising the methane concentration to 8%, and the deposited diamond wafer showed good thermal conductivity of 12–14 W cm −1 K −1 . Crack-free, homogeneous and flat diamond wafers with 100 mm diameter were obtainable.

The results of a round robin series of measurements of the thermal conductivity and thermal diffusivity of chemical-vapor-deposited (CVD) diamond are reported. The present round robin (RR2) is an outgrowth of an earlier series (RR1) aimed at understanding which measurement techniques are best suited to measuring the high conductivity of CVD diamond. RR2 includes diamond specimens of higher homogeneity, non-diamond specimens of lower conductivity as controls, and measurements by 14 laboratories using five techniques, with all techniques but one used by more than one laboratory. The data are converted to thermal conductivity at 25 °C to facilitate comparisons among specimens and laboratories. The statistical analysis excludes outliers using Chauvenet's criterion, resulting in data from typically two or three laboratories being excluded for each specimen. The analysis arrives at mean values in the range 1300–2000 W m −1 K −1 for the diamond samples, as expected because of the conditions of preparation, with uncertainties in the range 1.5–4%. For the non-diamond materials, SiC and AlN, the results are 268 W m −1 K −1 ±2.2% and 178 W m −1 K −1 ±2.5%, respectively. Comparing techniques, the d.c.-heated bar is found to be the most accurate, typically ±5% or better. Under favorable conditions, Angstrom's thermal wave method can apparently yield relative uncertainties of ±5–10%, and the mirage effect ±5–15%. Too few laboratories used the transient thermal grating and laser flash methods to make general comments on their accuracy, but one expects a comparable accuracy if used on specimens that are fine-grained and thermally isotropic. Deviations, sometimes large, from these optimal accuracies are examined, and it is suggested that certain experimental details are important for achieving accuracy. It is also found that the estimates of experimental uncertainty provided by most laboratories seriously underestimate the actual deviations of their data from the mean conductivity.

Measurements of thermal diffusivity of foil-shaped materials have been carried out using a photoirradiation-type AC calorimeter at room temperature. In this method the frequency effect, which is caused by heat loss from the sample to the environment, is readily detected in measurements of both amplitude and phase components of the AC temperature signal, Even though the chopping frequency is appropriate, the two diffusivities calculated from these two components differ from each other, Moreover, the difference between the two values increases when the chopping frequency increases. Simple vectorial calculation with the two components one from the amplitude and the other from the phase- permits the frequency ellect to be determined. The calculated result is the geometric average of the two diffusivities. This analytic method was tested with diamond film and SUS-304 foil. From these we confirmed that the vectorial analytic method gives similar diffusivity values for different frequencies indicating its reliability.

The combination therapy of low-dose diltiazem or bexatolol with digoxin can be a useful adjunct for achieving heart rate control with minimal side effects. But there has not been a study including patients with impaired left ventricular function and evaluating whether the beneficial effects of medication will be maintained during a follow-up period.The purpose of this study was three-fold: (1) to compare the efficacy of digoxin with low-dose diltiazem and digoxin with low-dose betaxolol on randomized crossover study; (2) to evaluate whether the beneficial effects of medication will be maintained after 7 months; (3) to evaluate the safety of the combination therapy in patients with impaired left ventricular function.We did a prospective randomized crossover study in 35 patients with chronic atrial fibrillation (AF) including 15 patients with left ventricular dysfunction. After enrollment, each patient was evaluated for heart rate, blood pressure, rate-pressure products, maximal exercise tolerance at rest and during symptom-limited treadmill test before medication, at 4 weeks after medication of digoxin (0.125-0.5 mg daily) with diltiazem (90 mg twice daily), and at 4 weeks after digoxin with betaxolol (20 mg once daily). We performed 24-h ambulatory electrocardiogram (ECG) in 15 patients at the end of each phase of treatment. We repeated symptom-limited treadmill test like above method in 15 patients at 7 months of medication.(1) Ventricular rates were significantly reduced in digoxin with low-dose betaxolol therapy at rest and during exercise (67 +/- 3, 135 +/- 5 (mean +/- S.E.M.) beats/min, respectively) in comparison to digoxin with low-dose diltiazem therapy (80 +/- 7, 154 +/- 5) (P0.05). (2) Rate-pressure products were significantly less in digoxin with low-dose betaxolol at rest and during exercise (85 +/- 4, 213 +/- 12 x 10(2) mmHg/min) than in digoxin with low-dose diltiazem therapy (105 +/- 6, 269 +/- 12) (P0.05). (3) Exercise capacity was significantly improved in digoxin with low-dose betaxolol (9.3 +/- 0.5 METS) or digoxin with low-dose diltiazem (9.7 +/- 0.5) in comparison to control state (8.3 +/- 0.5) (P0.05). (4) At 7 months evaluation, there was no significant difference between at 4 weeks and at 7 months. (5) Results on 24-h ambulatory ECG showed the same findings as on treadmill test. (6) Although side effects occurred more frequently in digoxin with low-dose betaxolol therapy, they were minimal and no patient had to withdraw medication. Worsening of left ventricular dysfunction was not observed.Our study suggested that (1) combination therapy of low-dose betaxolol with digoxin was more superior to low-dose diltiazem with digoxin in controlling ventricular rate and reducing rate-pressure products; (2) the effects controlling ventricular rate, reducing rate-pressure products and improving exercise capacity have been well maintained even after 7 months of medication with each combination therapy.

Three hundred and thirty-nine water samples obtained from 90 locations in Korea from 2007 to 2011 were tested for the presence of enteric viruses (EV), total coliforms (TC), and fecal coliforms (FC). A total culturable virus assay revealed that 89 samples (26.3%) were positive for EVs, the average concentration being 5.8 most probable number (MPN)/100 L. The Han river basin exhibited the highest contamination by EVs (occurrence, 41.3%; average concentration, 24.0 MPN/100 L). EV contamination was found more frequently in river water (occurrence, 33.6%; concentration, 8.4 MPN/100 L) than in lake water or groundwater. The concentration of EVs was highest in spring (7.7 MPN/100 L), whereas it was found most frequently in winter (36.1%). The number of TCs ranged from 0 - 1.2 × 10(5) colony forming units (CFU)/100 mL and that of FCs from 0-6.2 × 10(3) CFU/100 mL per sample. Statistical analyses showed that the presence of EVs, TCs and FCs did not correlate significantly with temperature or turbidity. In addition, presence of TCs and FCs was not significantly correlated with presence of EVs. In conclusion, TCs and FCs may not be accurate microbial indicators of waterborne EVs in Korean aquatic environments.

We report the case of a patient with fulminant myocarditis caused by influenza A virus, who presented with acute-onset heart failure and cardiogenic shock and was treated successfully with single dose of intravenous peramivir and with pharmacologic hemodynamic support. A 45-year-old Korean woman presented to our emergency department (ED) with shortness of breath and an episode of seizure that developed abruptly 5 hours before she arrived in the ED. She had a history of recurrent epileptic seizure 25 years ago, but denied other specific medical illnesses. In the ED, she was hypoxemic (arterial partial pressure of oxygen, 59.8 mmHg on room air) and chest radiography revealed bilateral alveolar infiltrates. A rapid antigen test for influenza A virus was positive, and she was administered a single dose of peramivir (300 mg) intravenously. Five hours later, the patient's dyspnea had worsened and she was hypotensive (blood pressure, 86/53 mmHg), requiring norepinephrine infusion. Further evaluation disclosed an increased cardiac troponin I level of 1.36 ng/mL and a depressed left ventricular ejection fraction of 30%. Under the diagnosis of influenza A-associated myocarditis and cardiogenic shock, she was managed with continuous critical care in the intensive care unit. On day 3, the patient's dyspnea began to resolve and her ventricular function returned to normal. Real-time polymerase chain reaction assays for influenza viruses in serial nasopharyngeal aspirates were positive for influenza A (hH3N2) with a threshold cycle value of 27.39 on day 2, but these became negative by day 4. The patient recovered and was discharged on day 9 after admission. In conclusion, this case indicates that intravenous peramivir might be an effective antiviral agent for the treatment of severe influenza A virus infection.

PURPOSE: The purpose of the study was to investigate fatigue, depression and sleep in young adult and middle-aged. METHOD: The convenient sample consisted of 415 subjects from 20 to 59 years old. Data were collected using a self-report questionnaire from July to October, 2001. The VAS-F and CES-D were utilized to measure the level of fatigue and depression. Sleep duration and sleep satisfaction were measured based on the subject's self-report. RESULT: The result of the study revealed that the level of fatigue and depression was higher among young adult than middle-aged. Considering age and gender, the level of fatigue and depression was higher among young adult women and middle-aged men. Depression and sleep satisfaction influenced on the fatigue. CONCLUSION: Health care providers need to concern about fatigue and depression in young adult women and middle-aged men. Especially, more concern and intervention programs are needed for young adult women and middle-aged men.

PURPOSE: This study was done to develop and evaluate multilingual education materials to promote health and adaptation to pregnancy for immigrant women in Korea. METHODS: This study had three procedures: First, contents of the education materials were developed according to pregnant women's needs, literature reviews, and group discussion. Details in contents were constructed based on Roy's adaptation model; Second, validity verification and translation of education materials were accomplished; Third, evaluation of the education materials was done through a survey of immigrant women. RESULTS: The education materials were developed in six languages (Korean, English, Chinese, Vietnamese, Filipino, and Cambodian). The title is "Healthy mother, happy family: eight-step guide to a healthy pregnancy". It was composed of an eight-step guide to healthy pregnancy, self-examination check list, websites for childbirth education and information, and guidelines on education materials in a brochure. In the evaluation, the average response score for the questionnaire items was high (3.23 on a four-point Likert scale). The average score for Cambodian immigrants was the highest of all immigrant women. CONCLUSION: Multilingual education materials developed in this research will help community health nurses to manage pregnancies for immigrant women and will be useful for health education for these women.

Background: Streptococcus agalactiae (Group B streptococcus, GBS) is known to be the leading cause of neonatal sepsis and meningitis in the United States and Europe. In addition, GBS infection has been increasingly noted in adults, particularly in those with underlying diseases, such as diabetes mellitus, malignancy and liver disease. A few studies reported that resistances to antibiotics, such as erythromycin, clindamycin, tetracycline are increasing. We report clinical and microbiological characteristics of GBS bacteremic patients in Jeju Island. Methods: We retrospectively analyzed medical records, such as age, sex, underlying disease, mortality, skin defects, laboratory results and antibiotic resistances of GBS in hospitalized adult patients who were diagnosed with GBS bacteremia from 2008 to 2013 in Jeju Island. Results: Twenty two adult patients were diagnosed as GBS bacteremia from 2008 to 2013. The mean age of GBS bacteremic patients was 66.2 years old. Of 22 bacteremic patients, fifteen patients (68%) were older than 60. Twenty patients (91%) of bacteremic patients had underlying diseases such as diabetes mellitus, malignancy and liver disease. Ten (45%) patients had skin defects which were on the lower extremities and buttock, fifteen (68%) patients had fever at the time of admission, twenty one (95%) patients were admitted via the emergency department. Two (9%) patients died. The mean white blood cell (WBC) count, percentile of neutrophil count, and C-reactive protein (CRP) levels were 11,488/μL, 84.3 %, 13.5 mg/dL respectively. All GBS isolates from bacteremia showed sensitivities to penicillin, ampicillin, and vancomycin, and showed resistances to erythromycin (25%), clindamycin (30%), and tetracycline (55%). Conclusion: Bacteremia caused by GBS was prevalent in adult patients with underlying diseases. Most of the GBS bacteremic patients were emergency cases, with a high body temperature, WBC, CRP level, and neutrophil count. Half of them had skin defects, which are considered a source of GBS bacteremia. (Ann Clin Microbiol 2014;17:9-13)

Les tensions superficielles des solutions de dichloro-2,2 trifluoro-1,1,1 ethane (R123) et de tetrafluoro-1,1,1,2 ethane (R134a) sont mesurees en fonction de la temperature

INTRODUCTION: Asthma and chronic obstructive pulmonary disease (COPD) are ongoing concerns to the health system. Poor inhaler technique results in less than optimal delivery of medicine to the lungs and consequent inadequate symptom control. AIM: This study aimed to assess inhaler technique amongst people with asthma and/or COPD. The secondary aims were to investigate who provided education on inhaler technique and whether age, gender or ethnicity was associated with poor inhaler technique. METHODS: People with asthma or COPD who presented to a community pharmacy with a prescription for a respiratory inhaler were invited to participate in the study. Participants completed a brief questionnaire and had their inhaler technique assessed against a standard checklist. RESULTS: There were 103 participants from 26 pharmacies, 86 with asthma and 17 with COPD. Just over half (52.5%) of the assessments indicated good inhaler technique, with 68% of people using the Turbuhaler having good technique compared to 53% for the pressurised metered dose inhaler (pMDI) with spacer and 47% for the pMDI alone. The majority of people (76%) received their initial inhaler technique instruction from their doctor. Over half of participants did not recall having their inhaler technique rechecked. DISCUSSION: After prescribing appropriate therapy, correct inhaler technique is a cornerstone of achieving adequate therapy. Rechecking inhaler technique is a gap in care that needs to be addressed from an interdisciplinary perspective. KEYWORDS: Asthma; chronic obstructive pulmonary disease; dry powder inhalers; metered dose inhalers; spacer inhalers

Acinetobacter baumannii (AB) is a common pathogen found in patients with hospital-acquired pneumonia all over the world. Community-acquired AB pneumonia, however, is very rare and has seldom been reported in Asia-Pacific countries. Community-acquired AB pneumonia has a fulminant course and is associated with a higher mortality than hospital-acquired AB pneumonia. In Korea, no case of fatal community-acquired AB pneumonia has been reported to date. Here, we describe the first fatal case of fulminant community-acquired AB pneumonia in Korea.

Background . The incidence of coronary artery spasm in oriental patients is higher than that in western patients. Oriental patients with variant angina (VA) frequently show normal or insignificant coronary artery stenosis by angiogram, compared with western patients. The prevalence of migraine and Raynaud's phenomenon in oriental patients with VA has not yet reported. Objective . We did a prospective study on the prevalence of migraine and Raynaud's phemonenon in patients with proven VA compared with those in two control groups using a radioisotope technique following ice water exposure. Simultaneously, we studied lipid profiles of each group. Methods and results . migraine was diagnosed if the score in part A totalled 7 or more of 26, and Raynaud's phemonenon was diagnosed if the score in part B totalled 4 or more of 11 by Miller et al. Technetium-99m-labeled red blood cells (99mTc-RBC) radionuclide angiography was performed in all patients. Patients were included in a prospective protocol. Patients were grouped as follows: Group I: 20 patients with proven VA; Group II: 30 patients with coronary artery disease; Group III: 31 patients without heart disease. Age and sex of patients were not statistically different among the three groups. Migraine was diagnosed in 8 patients (40.0%) of group I and in 6 patients (20.0%) of group II and in 12 patients (38.7%) of group III. Raynaud's phemonenon was reported in 2 (10.0%) of the patients in group I and in 5 (16.1%) of the patients of group III. The mean index ratio of the digital blood flow of right over left hand on static image was 0.85 ± 0.07 (mean ± S.E.M.) of the patients of group I, 0.73 ± 0.03 of the patients of group II and 0.74 ± 0.04 of the patients of group III. The mean flow index ratio of right over left hand of the digital blood flow on dynamic study was 0.51 of the patients of group I, 0.43 of the patients of group II and 0.43 of the patients of group III. The score of migraine did not differ significantly among the three groups. The score of Raynaud's phenomenon of patients with variant angina did not differ significantly from that of patients in the non-coronary control group, although it differed significantly from that of patients in the coronary control group. But, the prevalence of migraine and Raynaud's phemonenon (questionnaire and radionuclide angiography) in patients of group I did not differ significantly from that in groups II and III. In the end, more patients with variant angina than coronary or non-coronary control group did not reach the predetermined point level for the diagnosis of migraine and Raynaud's phenomenon. Lipid profiles were not significantly different among three groups. Conclusions . This result suggests that variant angina may not be a manifestation of a generalized vasospastic disorder in Korean patients.

The recent measurements of thermal conductivity of diamond are explained by the two-step model of normal process. The phonon scattering of isotopic defects is used as a main variable to fit the measurements. The enhancement of thermal conductivity at 300 K by reduction of the isotope concentration from 1.1% to 0.07% is as high as 16%. We also attempt to compare with other recent theoretical works which were calculated in the Callaway model.

We developed a colorimetric microwell plate hybridization assay (CoMPHA) for the specific detection of 5'-biotinylated amplified Mycobacterium tuberculosis DNA. The optical densities of the CoMPHA corresponded to the initial amounts of purified template DNA. Here, we show that the CoMPHA is useful in distinguishing the PCR-positive and PCR-negative samples.

The purpose of this study was to examine the relationships among social support (network and satisfaction), family function, and loneliness among elderly Korean women. A sample of 68 elderly Korean women, who were at least 60 years of age and lived in Seoul, Korea, was obtained. Data were collected by interview, using the translated Korean versions of the Revised University of California Los Angeles (UCLA) Loneliness Scale (RULS), Family APGAR, and Social Support Questionnaire 6. The results indicate that the subjects were moderately lonely (M = 45.04) and had moderately functional families (M = 5.60). The means for social support were 1.37 for network size and 4.17 for satisfaction. Twenty-one percent of the subjects lived with their spouses. The subjects who lived with their spouse had a larger number of network members than those who did not live with their spouse (t = −0.26, P

Single layer devices of indium tin oxide/Alq3∕Al were constructed with varying the active areas from 1to8mm2 and the thicknesses from 30to50nm. Average electric field across the Alq3 layer during the transient state was estimated from the accumulated charges at the interfaces of the devices. The electron mobility could thus be calculated by assuming that the injected charge carriers moved under the average electric field rather than the instantaneous field. The resulting mobility could be determined uniquely in a device thickness. The electron drift mobility was shown to behave similarly to the time-of-flight results.

Background: Remnant lipoproteins are the lipolytic degradation product of the triglyceride-rich lipoproteins produced by the liver (very-low-density lipoprotein cholesterol) and intestine (chylomicrons). Recent studies have demonstrated a correlation between remnant lipoproteins and cardiovascular risk. Our study assessed the relationship between obesity and remnant lipoproteins and evaluated the factors related to remnant lipoprotein in children and adolescents. Methods: Body mass index (BMI), waist circumference, systolic and diastolic blood pressures, body fat mass, total abdominal fat, visceral and subcutaneous fat areas, total cholesterol, triglyceride (TG), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C) and remnant lipoprotein cholesterol (RLP-C) were measured in 135 children and adolescents (67 boys and 68 girls). Plasma RLP fractions were isolated using an immunoaffinity gel containing specific anti-apoB-100 and anti-apoA-I antibodies. The subjects were divided into three groups: the low (< 50 percentile), mid (50~84 percentile), and high (≥ 85 percentile) BMI groups. Results: RLP-C was significantly correlated with age, sex, BMI, waist circumference, systolic and diastolic blood pressures, visceral and subcutaneous fat areas, visceral fat area to subcutaneous fat area ratio (VSR), total cholesterol, TG, HDL-C, apoB, and HOMA-IR. From a multivariate regression analysis, TG (β = 0.928, P < 0.001) was found to be independently correlated with RLP-C. After excluding TG as an independent variable, a multivariate regression analysis revealed that the HOMA-IR (β = 0.231, P = 0.007) and systolic blood pressure (β = 0.169, P = 0.046) were independently associated with RLP-C. Conclusion: RLP-C was significantly higher in obese children and adolescents. TG, systolic blood pressure, and insulin resistance were related to remnant lipoproteins. (J Kor Soc Endocrinol 21:311~318, 2006)

Background: Corticosteroids are known to be significant prognostic parameters in sepsis. Recently, an absolute and relative insufficiency of the corticosteroids system has often been reported to often develop particularly in severe sepsis. Degree of such an adrenal insufficiency not only has prognostic implications but also can be used to guide corticosteroids replacement therapy. The 24-hour urinary cortisol levels as well as serum cortisol concentrations were measured to assess the clinical significance and their relationship with the other parameters of sepsis, and also evaluated the clinical implications of the relative adrenal insufficiency. Methods: 26 consecutive patients with sepsis were enrolled. The basal random serum cortisol, ACTH, ADH, lactate levels and 24-hour urinary free cortisol amount were measured. The rapid ACTH (250 μg) stimulation test was also performed. Results: Basal serum cortisol levels were higher in the non-survivors than in the survivors. The 24-hour urinary free cortisol levels were higher in the patients with severe sepsis than in those without. The serum cortisol levels strongly correlated with the serum ADH and lactate levels. The 24-hour urinary free cortisol levels strongly correlated with the serum cortisol and lactate levels. The fractional changes in the cortisol levels after the rapid ACTH stimulation tests correlated with the serum cortisol, ADH, and lactate levels. Conclusion: Both the serum cortisol and 24-hour urinary cortisol were found to be significant prognostic factors in sepsis, and showed a strong correlation with the other parameters. The relative adrenal insufficiency might also be an important clinical parameter. (Tuberc Respir Dis 2006; 61: 356-365)

Background: The response rates and survival following allogeneic bone marrow transplantation (BMT) or immunosuppressive treatment were compared in severe aplastic anemia (SAA) and the prognostic factors related with survival identified. Methods: Medical data of SAA patients, treated with BMT or immunosuppressive therapy (IST) at the Ajou University Hospital, between January 1995 and December 2005, were retrospectively analyzed. Results: A total of 43 patients were evaluable; 18 (41.9%) were treated with IST (antithymocyte globulin plus cyclosporine A plus steroid) and 25 (58.1%) with allogeneic BMT. In the IST group, the response rate was 77.8% (2 complete and 12 partial remissions), with two treatment failures. As later complications, acute myeloid leukemia developed in 1 patient and myelodysplastic syndrome developed in 2. In the BMT group, the response rate was 92.0% (18 complete and 5 partial remissions) (P

Purpose To examine the relationships among loneliness, social support, and family function in elderly Korean. Method The sample for this study were 290 elderly Korean who were at least 60 years of age. Data were collected by interview using the translated Korean versions of the Revised University of California Los Angels Loneliness Scale(RULS), Family APGAR, and Social Support Questionnaire 6. Result Subjects were moderately lonely and had moderately functional families. Means for social support were 1.42 for network size and 4.09 for satisfaction. Subjects who lived with their spouses had a larger number of network members than who did not live with spouses. However, living with spouses was not associated with social support satisfaction. The level of loneliness was related negatively to the level of social support network, social support satisfaction and family function in this study. Social support satisfaction and Family function were the significant predictor of loneliness. Conclusion The number of social supporter and satisfaction and family function should be considered in nursing intervention to decrease the level of loneliness in older adults. Further studies and efforts will be needed to reduce the level of loneliness in older adults.

To identify osteoporosis and examine the relationship between health behavior and the self-efficacy of middle-aged women, a descriptive survey was conducted. The subjects were 465 healthy female residents of Kyunggido, Korea, who underwent ultrasound measurement and a health examination at the Kangmeung-Ci Health Center between July and August 2000. They were 40 to 60 years old, with a mean age of 46.7 years. The subjects completed a self-reported questionnaire that consisted of seven items concerning health behavior and twelve items concerning self-efficacy related to osteoporosis. Bone density was evaluated from ultrasound measurements of the right heel. All the data were analyzed using the program SAS-PC. The study found that the mean T score related to bone density was -1.30, and ranged from -3.52 to 3.06. Based on the T score, 74.8% of the subjects were normal, 12.9% had osteopenia, and 12.3% had osteoporosis. The mean osteoporosis self-efficacy score was 41.17 and ranged from 12 to 60. Osteoporosis self-efficacy differed significantly with health behavior related to health supplementary food (t=5.63, p=.018), exercise (t=6.65, p=.010), alcohol drinking(t=10.80, p=.001), and smoking (t=10.23, p=.001). A community-based health promotion program should be developed to prevent osteoporosis in middle-aged women.

We undertook this work to compare the treatment efficacies and the changes of quality of life after pelvic floor muscle (PFM) exercise and the functional electrical stimulation (FES)-biofeedback treatment, both of which are being widely used as conservative treatment methods for female urinary incontinence. We randomly selected 60 female incontinence patients who visited our department and divided them evenly into two groups. They were treated for a period of 6 weeks. The subjective changes in the severity of incontinence and discomfort in daily and social life were measured using a translated version of the questionnaire by Jackson. Objective changes of pelvic muscle contraction force were measured using a perineometer. Pre- and post-treatment maximal pelvic floor muscle contractile (PMC) pressure and changes in the severity of urinary incontinence and discomfort of the two groups showed statistically significant differences (p