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OBJECTIVES: The purpose of this study was to develop and validate a clinical prediction rule to screen patients at risk of vancomycin-resistant enterococci (VRE) carriage at intensive care unit (ICU) admission in a hospital setting with low VRE prevalence. METHODS: This study was retrospectively conducted in the ICUs of a university-affiliated hospital in Korea, where active surveillance cultures for VRE had been run at ICU admission and weekly thereafter. In the derivation cohort from April 2008 to September 2010, risk factors for VRE carriage at ICU admission were determined and assigned weighted point values using a multivariate logistic regression model. In the validation cohort from October 2010 to March 2011, predictability of the prediction rule was evaluated. RESULTS: Of a total of 4445 cultures taken from patients at ICU admission, 153 (3.4%) patients carried VRE. In the derivation cohort, independent risk factors (assigned points) for VRE carriage at ICU admission were ICU readmission during hospitalization (1 point), chronic obstructive lung disease (2 points), recent antibiotic treatment (3 points) and recent vancomycin use (2 points). In the validation cohort, the sensitivity, specificity, and positive and negative predictive values of the prediction rule, on the basis of risk scores ≥3 points, were 84.2%, 82.5%, 15.2% and 99.3%, respectively. CONCLUSIONS: This clinical prediction rule for identifying VRE carriage at the time of ICU admission is expected to markedly reduce the screening volume (by 80.1%) in our healthcare facility. For use in clinical practice, the rule needs to be prospectively validated in other settings.

This study examines the origin of dolls as well as how the role and types of various dolls have changed in a comparison of the functions of dolls before and after century. In addition, this study analyzes symbolic characteristics appearing in doll costumes. First, doll costumes (used in child play) represent sexual roles and various role models that are taught to children. Second, they reflect the fashion trends of that time and appear in the most beautiful forms that pursue the ideals of the time where doll costumes symbolize the latest fashion of the time. Third, the culture of doll costumes symbolizes cultural identity that show native customs, art, culture, and ethnic characteristics. Lastly, a mania society for dolls and collector groups are formed that share individual sensitivity. Members of those groups have feelings of solidarity and homogeneity through doll costumes that they have decorated and expressed themselves that show the reinforcement of a group by doll costumes.

The purpose of this dissertation is to examine the various types of hooded garments that have been worn after the century, and to analyze the aesthetic values of them. The study examined various types of hooded garments with diverse significances based on literature and case studies on the history of garments, news paper articles and the Internet. Since the century, there has been a variety of hooded garments, such as monk dresses, hoodies, anoraks, duffle coats, some protective clothing, and designers` hooded clothes. Through this research, the study found that the aesthetics of hooded garments after the mid-20th century were as follows: physical protection, anonymity, psychological refuge, fashionability and high-functionality.

Transferred multi-walled carbon nanotube (MWCNT)-modified platinum thin-film immunosensing electrode material was engineered on a glass substrate and fabricated a fully-integrated electrochemical three-electrode system for monitoring Legionella pneumophila. The transferred MWCNT film was treated with oxygen plasma to improve its electrochemical response and electrical conductivity. We voltammetrically characterized and optimized the electrochemical performance of the fabricated electrode for direct detection of Legionella pneumophila-specific peptidoglycan-associated lipoprotein (PAL) and maltose binding protein (MBP) peptidoglycan-associated lipoprotein (MBP-PAL) fusion. The latter, as an intermediate product to yield the former, has important roles in the growth and purification of PAL, which commercial enzyme-linked immunosorbent assay (ELISA) kits require as a target substrate. Consequently, direct electrochemical detection of MBP-PAL compared to PAL by square-wave voltammetry showed a greater than 50% increase in sensitivity with a lower detection limit of 5 pg mL(-1). We also investigated the affinity properties by determining kinetic parameters of the PAL and the MBP-PAL in relation to polyclonal antibodies immobilized on transferred MWCNT substrates using Michaelis-Menten assumptions and a Hanes-Woolf plot. This new method presented herein could save the time and effort for the separation and purification of PAL form MBP-PAL fusions that are required for performing ELISA-based immunoassay.

Background and objective: Community-acquired pneumonia (CAP) is generally considered to be a major cause of morbidity and mortality. There is much controversy regarding the optimal choice of antibiotics for patients with CAP. The aim of this study was to identify the antibiotics prescribed for adults hospitalized with CAP in Korea during a calendar year. Methods: This population-based, descriptive epidemiological study was performed using data from nationwide health insurance claims from 1 January 2004 to 31 December 2004. The study population was adults (≥18 years old), who had been hospitalized with CAP as determined by discharge diagnosis, and who had been treated with antibiotics for ≥3 days. The exclusion criteria were tuberculosis, underlying malignancies and potential nosocomial pneumonia, based on the department providing care, or surgery reports during the admission. Results: Of the 5592 adults hospitalized with CAP, data for 3662 (65.5%) patients was eligible for inclusion in the analysis. This included data for 1899 (51.9%) males, and 2045 (55.8%) patients ≥65 years of age. The most frequently prescribed antimicrobial regimen was β-lactam/β-lactamase inhibitors and fluoroquinolones in combination (31.0%), followed by β-lactam/β-lactamase inhibitors plus macrolides (30.2%), monotherapy (17.0%), β-lactam/β-lactamase inhibitors plus aminoglycosides (12.9%), β-lactam/β-lactamase inhibitors plus clindamycin (4.9%), and cephalosporins plus fluoroquinolones (2.5%). Monotherapy included, in decreasing order of use, cephalosporins (6.0%), fluoroquinolones (3.5%), β-lactam/β-lactamase inhibitors (2.3%) and macrolides (2.2%). Conclusions: In this study, patterns of antimicrobial prescription for patients hospitalized with CAP were assessed for the first time in Korea. There was divergence from the 2009 Korean guidelines for the treatment of CAP, reinforcing the need for assessment of physicians' adherence to the guidelines.

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) remain important causes of morbidity and mortality. Increasing antimicrobial resistance has aroused the concern of the failure of antibiotic treatment.To determine the distribution of the bacterial isolates of HAP and VAP, their antimicrobial resistance patterns, and impact of discordant antibiotic therapy on clinical outcome in Asian countriesA prospective surveillance study was conducted in 73 hospitals in 10 Asian countries from 2008-2009. A total of 2,554 cases with HAP or VAP in adults were enrolled and 2,445 bacterial isolates were collected from 1,897 cases. Clinical characteristics and antimicrobial resistance profiles were analyzed.Major bacterial isolates from HAP and VAP cases in Asian countries were Acinetobacter spp., Pseudomonas aeruginosa, Staphylococcus aureus, and Klebsiella pneumoniae. Imipenem resistance rates of Acinetobacter and P. aeruginosa were 67.3% and 27.2%, respectively. Multidrug-resistant rates were 82% and 42.8%, and extensively drug-resistant rates were 51.1% and 4.9%. Multidrug-resistant rate of K. pneumoniae was 44.7%. Oxacillin resistance rate of S. aureus was 82.1%. All-cause mortality rate was 38.9%. Discordant initial empirical antimicrobial therapy increased the likelihood of pneumonia-related mortality (odds ratio, 1.542; 95% confidence interval, 1.127-2.110).Acinetobacter spp., P. aeruginosa, S. aureus, and K. pneumoniae are the most frequent isolates from adults with HAP or VAP in Asian countries. These isolates are highly resistant to major antimicrobial agents, which could limit the therapeutic options in the clinical practice. Discordant initial empirical antimicrobial therapy significantly increases the likelihood of pneumonia-related mortality.

OBJECTIVES The aim of this study was to identify the risk factors for prolonged carriage of vancomycin-resistant Enterococcus faecium (VREF) in intensive care units (ICUs). METHODS A retrospective case-control study was performed in the ICUs of a university hospital in Korea from September 2006 to July 2009. VREF carriage was identified through weekly active surveillance rectal cultures. Clinical characteristics and the risk factors for VREF acquisition were compared between cases with prolonged VREF carriage (≥ 5 weeks, n = 58) and controls with shorter VREF carriage (

ZnO nanorods have been used on Au working electrodes of biosensors for enhancing biosensor characteristics. ZnO nanorods grown on working electrodes have been employed for fabricating not only glucose sensors but also electrochemical immunosensors for detecting Legionella pneumophilia. The sensitivity of these biosensors was enhanced substantially compared to typical electrochemical biosensors based on Au working electrode

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.

Background The national immunization program (NIP) of annual influenza vaccination to the elderly population (≥65 years of age) in the Republic of Korea (ROK) has been implemented since 1987. Recently, the 23-valent pneumococcal polysaccharide vaccine (PPV23) through the NIP has been provided to the elderly population in the ROK since May 2013. The aim of this study was to assess PPV23 and influenza vaccine (IV) effectiveness in preventing pneumococcal pneumonia (PP) among elderly patients ≥65 years of age. Methods A case–control study using a hospital-based cohort was conducted. Cases of PP including bacteremic PP and nonbacteremic PP were collected from 14 hospitals in the pneumococcal diseases surveillance program from March 2013 to October 2015. Controls matched by age and sex in the same hospital were selected. Demographic, clinical information, and vaccination histories were collected. Previous immunization was categorized into “vaccinated” if a patient had received vaccines as follows: PPV23 (4 weeks to 5 years) and IV (2 weeks to 6 months) prior to the diagnosis of PP for case patients and prior to the hospital admission for control patients. Adjusted odds ratio (OR) was calculated, controlling for underlying medical conditions. Vaccine effectiveness was defined as (1 – OR) × 100. Results During the study period, a total of 661 cases (104 bacteremic PP cases and 557 nonbacteremic PP cases) and 661 controls were enrolled for analyses. For overall patients ≥65 years of age, there was no significant vaccine effectiveness against PP. For young elderly patients with 65–74 years, IV alone (1.2%, [95% confidence interval (CI) −95.3% to 50.0%]) and PPV23 alone (21.9%, [95% CI −39.0% to 56.1%]) were not effective. However, significant vaccine effectiveness of PPV23 plus IV against PP was noted (54.4%, [95% CI 6.9–77.7%], P = 0.031). For older elderly patients ≥75 years of age, no significant vaccine effectiveness was observed. Conclusion Our study indicates that PPV23 plus IV may be effective in preventing PP among young elderly patients with 65–74 years, suggesting additive benefits of influenza plus PPV23 vaccination. Further studies are required to confirm the persistent additive protective effectiveness. Disclosures All authors: No reported disclosures.

The aim of this study is to evaluate the usefulness of serum procalcitonin (PCT) as a diagnostic biomarker for distinguishing pneumonia from pulmonary edema in patients presenting with pulmonary infiltrates on chest radiography. A comparative study was performed retrospectively in a university-affiliated hospital, from May, 2013 to April, 2015. Adult patients (≥18 years) who showed pulmonary infiltrates on chest radiography and had blood tests with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), PCT, and N-terminal pro-b-type natriuretic peptide (NT-proBNP) on admission were included in the study. Clinical parameters collected on admission were compared between the case group (n = 143) with pneumonia and the control group (n = 88) with pulmonary edema alone. During the study period, a total of 1217 patients were identified. Of them, a total of 231 patients were included in analyses based on exclusion criteria. In the multivariate logistic regression analysis, PCT ≥0.25 ng/mL, ESR ≥35 mm/h, CRP ≥18 mg/L, NT-proBNP ≤200 pg/mL, underlying neurologic diseases, fever, sputum, absence of cardiomegaly, and a low Charlson comorbidity index were independently associated with pneumonia. For this model, the sensitivity, specificity, positive predictive value, and negative predictive value in distinguishing between the 2 groups were 90.2%, 79.6%, 87.8%, and 83.3%, respectively, with an area under the curve of 0.93. This study suggests that the practical use of PCT in conjunction with clinical data can be valuable in the differential diagnosis of pulmonary infiltrates and guidance for clinicians to prevent antibiotic misuse.

Background A single administration of laninamivir octanoate, a long-acting neuraminidase inhibitor, against influenza infection has been proven effective in nonclinical studies. This study evaluated the clinical efficacy of laninamivir octanoate for the treatment of adult influenza patients. Methods A double-blind, randomized controlled trial examined whether laninamivir octanoate was noninferior to oseltamivir. A total of 1003 patients aged ≥ 20 years with febrile influenza symptoms for no more than 36 h were randomized to receive either 40 mg of laninamivir octanoate, 20 mg of laninamivir octanoate, or oseltamivir. Laninamivir octanoate was inhaled once on day 1, and oseltamivir (75 mg) was administered orally twice daily for 5 days. The primary end point was the time to illness alleviation. Results A total of 996 patients were included in the primary analysis (40-mg laninamivir octanoate, n = 334; 20-mg laninamivir octanoate, n = 326; and oseltamivir, n = 336). The median time to illness alleviation in the 40-mg laninamivir octanoate, 20-mg laninamivir octanoate, and oseltamivir groups was 73.0, 85.8, and 73.6 h, respectively. The difference between laninamivir octanoate and oseltamivir was -0.6 h (95% confidence interval, -9.9 to 6.9 h) for the 40-mg group and 12.2 h (95% confidence interval, -1.5 to 17.2 h) for the 20-mg group. The upper limits of the 95% confidence intervals were less than the prespecified noninferiority margin (18 h). The proportion of patients shedding virus at day 3 was significantly lower in the 40-mg laninamivir octanoate group than in the oseltamivir group (P = .006). Conclusions A single inhalation of laninamivir octanoate is effective for the treatment of seasonal influenza, including that caused by oseltamivir-resistant virus, in adults. Clinical trials registration NCT00803595.

Liposuction is the most widely performed cosmetic procedure in the world, and is considered safe and without serious complications. However, necrotising fasciitis has been documented as a rare complication following abdomen and thigh liposuction. We present a case of necrotising fasciitis in a 22-year-old female who underwent cosmetic liposuction in both calves. The diagnosis of necrotising fasciitis was delayed, leading to multi-organ dysfunction and skin necrosis with consequent massive skin loss. Non-cosmetic physicians are generally unfamiliar with liposuction-induced complications, and may not suspect necrotising fasciitis due to its rarity. However, awareness of its clinical features is critical since early diagnosis and prompt surgical debridement can prevent significant morbidity and even death.

An electrochemical immunosensor based on patterned plasma-functionalized multiwalled carbon nanotubes (pf-MWCNTs) working electrode for Legionella pneumophila detection is described in this paper. Polyclonal antibody was immobilized using passive adsorption and covalent immobilization on the surface of the pf-MWCNTs. Various dilutions of Legionella 19-kDa peptidoglycan-associated lipoprotein (PAL) were added onto the electrode surface and incubated. The assay was then completed using polyclonal antibody conjugated to horseradish peroxidase (HRP) as the enzyme label. 3,3',5,5'-Tetramethylbenzidine dihydrochloride (TMB)/substrate solution (H2O2) was used as the mediator/substrate system. Electrochemical detection was conducted using cyclic voltammetric at 500 mV versus silver/silver chloride (Ag/AgCl) reference electrode. L pneumophila detection of 0.16 ng ml(-1) and similar to 0.0025 ng ml(-1) was achieved respectively for passive adsorption and covalent immobilization. (C) 2010 Elsevier B.V. All rights reserved.

The number of persons infected by HIV/AIDS has consistently increased in Korea since the first case of HIV/AIDS infection in 1985 and reached 15,208 by 2016. About 1,100 new patients with HIV/ AIDS infections have emerged every year since 2013. In Korea, the Korea HIV/AIDS Cohort Study was established for the evidenced-based prevention, treatment, and effective management of patients infected with human immunodeficiency virus (HIV) in December 2006. This study monitored 1,438 patients, who accounted for about 10% of all patients with HIV/AIDS in Korea, for 10 years with the following aims: (1) to develop an administrative system for the establishment of a HIV/AIDS cohort-based study; (2) to standardize methodologies and the case report forms; and (3) to standardize multi-cohort data and develop a data cleaning method. This study aims to monitor at least 1,000 patients (excluding those for whom investigation had been completed) per year (estimated number of patients who can be monitored by January 2018: 939). By December 2016, the sex distribution was 93.3% for men, and 6.7% for women (gender ratio, 13.9:1.0), and 98.9% of all participants were Korean. More than 50.0% of the participants were confirmed as HIV positive after 2006. This study reports competitive, long-term research that aimed to develop policies for the prevention of chronic infectious diseases for patients with HIV. The data collected over the last decade will be used to develop indices for HIV treatment and health promotion.

This paper examines the advertisements for mass-produced women`s clothing, which appeared in the 1980s issues of the fashion magazine Wolganmeot. This study explores the communicative aspect of fashion advertisements of the 1980s as a platform for complex and dynamic interactions between fashion brands, female consumers, and the rapidly changing social, cultural, and economic conditions of the period. The research focuses on advertisements in the formal and character casual categories that targeted young, urban, and career-seeking women. Based on the analysis of the visual and textual elements of the advertisements from a pragmatics perspective, this paper concludes that fashion brands sought to highlight an `intelligent`, `urban`, and `individualistic` image of women. It also proposes that the prevalence of assertive and straightforward textual elements, copies, indicates the efforts of fashion brands to stabilize and reinforce the advertising messages in the fast-evolving landscapes of the fashion industry and changing consumption habits.

Received 14 January 2010; returned 22 January 2010; revised 28 January 2010; accepted 30 January 2010 Objectives: The high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) coupled with an increase in vancomycin use have induced vancomycin tolerance in MRSA, adversely affecting the outcome of MRSA bacteraemia. This study aimed to identify predictors of persistent MRSA bacteraemia (PMRSAB) in patients treated with vancomycin. Methods: A retrospective, case-control study was performed at a university hospital in Korea from January 2006 to February 2009. Subjects included 96 patients who had MRSA bacteraemia and received vancomycin under therapeutic drug monitoring. We compared the clinical characteristics, management and outcomes of cases with PMRSAB (� 7d ays,n¼31) with controls with non-PMRSAB (� 3 days, n¼32). Vancomycin MICs were determined by the Vitek 2 system. Results: Of 96 patients with MRSA bacteraemia, MRSA isolates from 21 patients (21.9%) showed a vancomycin MIC of 2 mg/L. Independent predictors of PMRSAB were: retention of implicated medical devices [odds ratio (OR), 10.35; 95% confidence interval (CI), 1.03‐104.55]; MRSA infection of at least two sites (OR, 10.24; 95% CI, 1.72‐61.01); and vancomycin MIC of 2 mg/L (OR, 6.34; 95% CI, 1.21‐33.09). The frequency of side effects and mean trough serum vancomycin concentrations were not significantly different between the two groups. Sixteen patients with PMRSAB subsequently received teicoplanin+arbekacin, linezolid or quinupristin/ dalfopristin, due to vancomycin failure or intolerance. Conclusions: To minimize the risk of PMRSAB, early removal of implicated devices and evaluation for metastatic infections should be encouraged. Alternative antibiotic therapy is warranted for infections due to isolates with elevated vancomycin MICs, as well as for the high rates of side effects.

This study develops a coverall design for the body shape and movement of infants. This research analyzed these processes: 1. The current coverall styles preferred for infants. 2. The appropriate products for the real size, body shape, movement, and fit of infants. 3. The observations of the 6 months to 9 months movement and development of infants. 4. The design and creation of a new coverall base in this study, and to check the suitable test the developed coverall design for the infant. The result of this study are: A coverall for infants that lie or crawl on the floor must avoid opening in the center front and a gore has to be added at the crotch of the pants for the better movement of infants. These ways provide infants a neat appearance and easy movement. The test of developed designs shows that the developed coverall design covers the size gap of the trunk loop according to the growth of the infant and the movement of the legs; in addition it provides a positive aesthetic effect. The waistline in the developed coverall (a waistline that should exist lower than the body waistline of the infant) can reduce seam stress because the pressure of the seam line can be absorbed in a dipper. It is one of the suitable design points for infants lying prone all day long in this study.

"Lolita," a novel by a Russian-American novelist, Vladimir Nabokov, has been the center of controversy since its first publication in 1955. As it gained wide fame across culture, it has exercised a great influence, altered or developed to diverse forms. Lolita, the title of the novel as well as the heroine`s name, now takes a significant part in our society through all cultures and is used as various meanings and symbols. The purpose of this study is to reanalyze and reinterpret the current use of Lolita based on the characteristics initially portrayed in Nabokov`s novel. The traits of the heroine were categorized into purity, seductiveness, and dualism and the commercial use of each in the mass media and fashion in Korea was closely examined. First, purity was interpreted as the archetypal image of a 12-year-old girl, while seductiveness was construed to involve temptation and enticement, ultimately leading a man astray. The dualism of an under-aged sexualized nymphet delineated in the novel as a poor little girl as well as a depraved temptress was stated as another trait of Lolita.

Summary Objectives To evaluate the clinical outcome and predictive factors of recurrence among patients with Kikuchi's disease. Methods Between January 2001 and December 2006, all patients with Kikuchi's disease were included in the study. Data were collected on co-morbidities, clinical manifestations, and ultrasound/laboratory findings, and the differences were compared between recurrent disease and non-recurrent disease groups. Results The study included 102 patients with a mean age of 26.7 years. Among these patients, three developed systemic lupus erythematosus during the follow-up period, while two cases were later associated with tuberculosis. Eight patients (7.8%) experienced early relapse and 13 (12.7%) showed late recurrence. Patients with recurrent episodes were more likely to have fever and fatigue with extranodal involvement. Compared to the non-recurrent cases, recurrent cases remained symptomatic for a rather longer duration. The positive rate of the fluorescence anti-nuclear antibody (FANA) test was significantly higher in the recurrent disease group compared to the non-recurrent disease group. Conclusions Kikuchi's disease took a self-limiting clinical course in most cases, but the recurrence rate found in the present study was higher than that of previous reports. Kikuchi's disease might be a phenotype of diverse disease entities. The prognosis is different according to the underlying cause. The FANA test would be useful in predicting recurrence.

Religion is the symbolic form and action, linking the ultimate condition of life with human beings. Religious idea grasps the world through symbols and gives birth to the action through symbols. This research put its purpose in elucidating the effect of religion on the costume and its mechanism. It`s focus is centered on Buddhism, Hinduism, and Islam which are among the world high religions. Part of this research also examines the mechanism in which several composing factors are expressed with rituals and manifested with costumes, this process was diagrammatized and suggested. The composing factors of religion such as belief system, experiences, community, and rituals are closely related. Ritual especially, is the symbolic action, practice, and the way of rescue, expressing religious meaning. Religious rituals such as imitative rituals, positive or negative rituals, sacrificial ritual, and rites of passage have been expressed with religious music or figurative art such as costume, construction, and art as well as religious ritual like ancestral rites. Religion has had a great effect on the overall culture including costume as a belief system by lightening the meaning of life and suggesting the solutions to the human problems such as anxiety or conflict.

The costume of Islam cultural area has been affected by the strict social structure, formed by religion, and traditional costume of Islam has been maintained up to these days under the influence of religion. Islam Traditional Costume, which is the succession of the traditional costume of southwest Asia region, became armed with the form of closed costume due to the chastity and oppression. There are figurative features of Islam Folk Costume; first, the dimensional form due to the ampleness, covering the body, second, the reinforcement of closed form such as chador and burqa, third, the symbolism such as the adornment or incantational ornament, which has been inherited from the former times of Islam era, fourth, the color, simplified with black and white. The aesthetic values of Islam folk costume are represented with `The beauty of abstinency`, suppressing the ornamentation and color, caused by the strict social atmosphere under the influence of the form of traditional costume and religion, `The beauty of concealment` due to the closeness, with affluent costume forms, covering the body and even concealing the face, and `The beauty of symbol` which is demonstrated with incantational ornamentation of face and interior decoration. In some nations amongst Islam nations, the wearing of hijab is strictly regulated but black chador and burqa are regarded as negative symbols, representing the closeness and oppression of Islam. It is the product of Orientalism from the western perspective. The Islam Hijab culture is the symbol of oppression towards women, but, on the other hand, it is the device to protect women and the traditional culture, symbolizing the identity.

A total of 9599 isolates of Gram-negative bacteria (GNB) causing urinary tract infections (UTIs) were collected from 60 centres in 13 countries in the Asia-Pacific region from 2010-2013. These isolates comprised Enterobacteriaceae species (mainly Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Klebsiella oxytoca, Enterobacter cloacae and Morganella morganii) and non-fermentative GNB species (predominantly Pseudomonas aeruginosa and Acinetobacter baumannii). In vitro susceptibilities were determined by the agar dilution method and susceptibility profiles were determined using the minimum inhibitory concentration (MIC) interpretive breakpoints recommended by the Clinical and Laboratory Standards Institute in 2015. Production of extended-spectrum β-lactamases (ESBLs) amongst E. coli, K. pneumoniae, P. mirabilis and K. oxytoca isolates was determined by the double-disk synergy test. China, Vietnam, India, Thailand and the Philippines had the highest rates of GNB species producing ESBLs and the highest rates of cephalosporin resistance. ESBL production and hospital-acquired infection (isolates obtained ≥48 h after admission) significantly compromised the susceptibility of isolates of E. coli and K. pneumoniae to ciprofloxacin, levofloxacin and most β-lactams, with the exception of imipenem and ertapenem. However, >87% of ESBL-producing E. coli strains were susceptible to amikacin and piperacillin/tazobactam, indicating that these antibiotics might be appropriate alternatives for treating UTIs due to ESBL-producing E. coli. Fluoroquinolones were shown to be inappropriate as empirical therapy for UTIs. Antibiotic resistance is a serious problem in the Asia-Pacific region. Therefore, continuous monitoring of evolutionary trends in the susceptibility profiles of GNB causing UTIs in Asia is crucial.

Patients infected with human immunodeficiency virus (HIV) may develop mental health problems such as anxiety and depression, which negatively impact of disease progression. We investigated factors associated with the prevalence of anxiety and depression symptoms among HIV-infected patients in Korea. A total of 840 HIV-infected patients who participated in the Korea HIV/AIDS Cohort Study from 2006 to 2012 were evaluated. Socio-demographic, epidemiologic, and clinical variables were obtained through standardized questionnaires. The State-Trait Anxiety Inventory and Beck Depression Inventory were used to assess the symptoms of anxiety and depression. Multiple logistic regression analyses were performed to identify factors associated with symptoms of anxiety and depression. The prevalence of anxiety and depressive symptoms among HIV-infected patients was 32% and 36%, respectively. Ex-smoker and persistent symptoms for more than one week within the past six months and diagnosis of HIV infection within one year were associated with increased anxiety symptoms (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.09-2.69; OR 1.52, 95% CI 1.09-2.11; OR 1.49, 95% CI 1.02-2.20) and current smoking and persistent symptoms were also associated with increased depressive symptoms (OR 2.10, 95% CI 1.31-3.30; OR 1.87, 95% CI 1.25-2.79). Marital status, current smoking, current drinking, and persistent symptoms were associated with both increased anxiety and depressive symptoms (OR 1.75, 95% CI 1.07-2.88; OR 1.66, 95% CI 1.06-2.61; OR 1.88, 95% CI 1.18-2.99). The prevalence of anxiety and depressive symptoms among HIV-infected patients is higher than those estimated for the general population. This study shows the necessity to evaluate symptoms of anxiety and depression and suggest psychological support for HIV-infected patients who smoke or have persistent symptoms or have sexual partner or drink.

The intracellular pathogen Listeria monocytogenes presents characteristically as meningoencephalitis and bacteremia. Herein, we report an extremely rare case of empyema caused by serotype 4c L. monocytogenes in an immunocompromised patient. This case supports the inclusion of L. monocytogenes infection in the differential diagnosis of empyema in an immunocompromised patient.

For user convenience, we implement a user-friendly GUI program that plays a calibration tool for the coefficient variables of Steinhart-Hart equation. The proposed tool provides automatic modification of the coefficient variables used for the resistance-temperature measurement of NTC thermistor. In temperature measurement evaluation of PCR devices, the proposed tool yields 0.1C precision.

We conducted an epidemiologic study to understand temporal and spatial patterns of hemorrhagic fever with renal syndrome (HFRS) in the Republic of Korea (ROK). We estimated the incidence among civilians in endemic areas through the active surveillance system during the major epidemic periods, from September to Decem- ber, between 1996 and 1998. We also estimated the prevalence among Korean military personnel from 1995 to 1998. In addition, we assessed seroprevalence, sub- clinical infection rate, and vaccination rates in both civilians and military personnel. The incidence in civilians ranged from 2.1 to 6.6 per 100,000 person-months. The annual prevalence in the military personnel was 40-64 per 100,000 military popula- tions, and remained generally constant throughout the study period with seasonal variation. This is the prospective epidemiologic data set on HFRS in the ROK since the inactivated Hantaan virus vaccine was licensed for use in the late 1990s. These results will be invaluable in establishing a national immunization program against HFRS.

Spontaneous bacterial peritonitis (SBP) is an ascitic fluid infection as a complication of end stage liver disease. The outcome is related to the severity of hepatorenal function, gastrointestinal bleeding, and many others; however it is not well known whether the infection acquisition sites have an effect on the prognosis of SBP. In order to identify the prognostic significance of the acquisition sites, we studied 106 patients who were diagnosed as culture positive SBP between October 1998 and August 2003. Thirty-two episodes were nosocomial and 74 were community acquired. Gram-negative bacilli such as Escherichia coli were dominant in both of the nosocomial and community-acquired SBPs. Despite significantly higher resistance to cefotaxime in nosocomial isolates compared to community-acquired isolates (77.8% vs. 13.6%, p=0.001), no difference was found regarding short or long term prognosis. Infection acquisition sites were not related to short or long term prognosis either. Shock, gastrointestinal bleeding and renal dysfunction were related to short term prognosis. Only Child-Pugh class C was identified as an independent prognostic factor of long-term survival.

Natural killer (NK)/T-cell lymphoma associated with Epstein-Barr virus (EBV) in a patient infected with human immunodeficiency virus (HIV) is very rare. The authors encountered a case of NK/T-cell lymphoma in a 36-year-old man who presented with an ulcerative mass on both tonsils. During assessment, HIV positivity was noted. The EBV was detected by EBV-encoded RNA 1 messenger RNA in situ hybridization and polymerase chain reaction for EBV-encoded nuclear antigen 1. On immunohistochemical staining, the infiltrated lymphoid cells of the tonsils demonstrated positvity for CD3, CD56, UCHL1, and granzyme, a finding compatible with NK/T-cell lymphoma. The patient received radiation therapy and chemotherapy, but died as a result of opportunistic infection of invasive aspergillosis after tumor recurrence. An autopsy was done with the consent of the patient’s family. To our knowledge, this is the first case in an HIV patient of NK/T-cell lymphoma of the tonsils associated with EBV, confirmed by autopsy. NK/T-cell lymphoma should be considered in the HIV-positive patients with an ulcerating tonsillar mass. doi: 10.1532/IJH97.A10316

A photometric immunosensor that can be used for on-site diagnosis has been constructed. The sensor system was assembled by partially superimposing a nitrocellulose membrane strip (the lower) containing an immobilized antigen on the surface with a glass fiber membrane strip (the upper) including two electrodes on the opposite surfaces. To amplify the signal, we introduced a liposome, containing ruthenium molecules trapped in the core, chemically coupled to an antibody specific to the analyte (e.g. Legionella antigen). In the presence of the analyte, immune complexes were formed by antigen-antibody reactions upon addition of the immuno-liposome into a sample. This mixture was then absorbed by the capillary action from the bottom of the membrane strip. The liposome particles in the complexes were carried by a medium through the antigen pad without interaction, while free immuno-liposome was trapped by immune reactions on the pad surfaces. The aqueous medium influx into the glass pad dissolved a detergent pre-located within the compartment and the liposome rupture thereby released ruthenium molecules into the solution. The molecules were oxidized on the electrode surfaces and produced an electro-chemiluminescence (ECL) in proportion to the analyte concentration. The signal generation based on ECL resulted in an exponential dose-response pattern and the analyte detection limit of 2 ng/ml was approximately 10-fold more sensitive than that obtained from a conventional system.

To evaluate the peptidoglycan-associated lipoprotein (PAL) antigen of Legionella pneumophila as a vaccine candidate, mice were immunized intramuscularly with pcDNA3-PAL and intraperitoneally with recombinant PAL (t-rPAL), which were compared for their ability to induce PAL-specific immune responses. The t-rPAL protein induced PAL-specific IgG antibody production significantly more than did pcDNA3-PAL. The IgG2a and IgG1 production was predominant after pcDNA3-PAL and t-rPAL administration, respectively. In particular, pcDNA3-PAL induced much higher PAL-specific cytotoxic T-lymphocyte responses than did t-rPAL. Furthermore, in vivo, CD19+ B-cell populations were dramatically increased by t-rPAL vaccination, suggesting a B-cell immunomodulatory activity of the lipoprotein. The PAL antigen was also conserved among Legionella species, as determined by PCR and immunoblot analyses. These results support a potential use of the t-rPAL protein and in particular DNA vaccines against Legionella infections.

Leptospirosis is a spirochetal zoonosis that causes an acute febrile systemic illness in humans. Leptospira sp. hemolysins have been shown to be virulence factors for the pathogenesis of leptospirosis. Previously, we cloned a hemolysin SphH of Leptospira interrogans serovar lai, a homologue of L. borgpetersenii sphingomyelinase (SphA), from a genomic library (S. H. Lee, K. A. Kim, Y. K. Kim, I. W. Seong, M. J. Kim, and Y. J. Lee, Gene 254:19–28, 2000). Escherichia coli lysate harboring the sphH showed high hemolytic activities on sheep erythrocytes. However, it neither showed sphingomyelinase nor phospholipase activities, in contrast to SphA which was known to have sphingomyelinase activity. Interestingly, the SphH-mediated hemolysis on erythrocytes was osmotically protected by PEG 5000, suggesting that the SphH might have caused pore formation on the erythrocyte membrane. In the present study, we have prepared the Leptospira hemolysin SphH and investigated its hemolytic and cytotoxic activities on mammalian cells. SphH was shown to be a pore-forming protein on several mammalian cells: When treated with the SphH, the sheep erythrocyte membranes formed pores, which were morphologically confirmed by transmission electron microscopy. Furthermore, the SphH-mediated cytotoxicities on mammalian cells were demonstrated by the release of LDH and by inverted microscopic examinations. Finally, the immune serum against the full-length hemolysin could effectively neutralize the SphH-mediated hemolytic and cytotoxic activities. In conclusion, these results suggest that the virulence of Leptospira SphH was due to the pore formation on mammalian cell membranes.

Rationale: Lymphomatoid granulomatosis is a very rare Epstein-Barr virus-driven lymphoproliferative disease. This disease has high mortality owing to its low incidence in conjunction with nonspecific presentations, which contribute to delays in diagnosis. Patient: An 87-year-old male had a week-long history of intermittent fever and general weakness. A chest radiograph showed multifocal patchy consolidations with nodular lesions. Diagnoses: Open lung biopsy using video-assisted thoracic surgery resulted in a diagnosis of grade III lymphomatoid granulomatosis. Three days after surgery, Mycobacterium tuberculosis complex was identified from the culture of sputum samples collected at admission. Intervention and outcomes: Antituberculous treatment was commenced first. However, after 34 days of antituberculosis medication, the patient died owing to aggravated lymphomatoid granulomatosis. Lessons: This case highlights the fact that rare diseases should also be considered in differential diagnosis, particularly with a common presentation such as multiple lung nodules. Furthermore, a diagnosis of pulmonary lymphomatoid granulomatosis was made after open lung biopsy. To our knowledge, this is the first case of lymphomatoid granulomatosis coexisting with active tuberculosis in the Republic of Korea, where tuberculosis is endemic.

Background Although the 13-valent pneumococcal conjugate vaccine (PCV13) showed good efficacy against pneumococcal disease in the the CAPiTA trial, the 23-valent pneumococcal polysaccharide vaccination (PPSV23) program has been ongoing for older adults aged ≥ 65 years in Korea since May of 2013. This study aimed to evaluate the cost-effectiveness of the current vaccination strategy (a single-dose PPSV23 vaccination) compared to a single-dose PCV13 vaccination and sequential PCV13-PPSV23 vaccinations in the elderly population aged ≥ 65 years. Methods Using a Markov model, the incremental cost-effectiveness ratios (ICERs) of three vaccination strategies were assessed in a societal context. The transition probabilities, utility weights to estimate quality adjusted life year (QALY), and disease treatment costs were either calculated or cited from published data and the Health Insurance Review and Assessment Service. Simulations were performed in hypothetical cohorts of Korean adults aged ≥ 19 years. The vaccine effectiveness of PPSV23 was cited from a Cochrane Review report, while PCV13 effectiveness data were gathered from the CAPiTA trial. Results Current PPSV23 vaccination strategies were cost-effective (ICER, $25,786 per QALY). However, the administration of PCV13 as a substitute for PPSV23 was shown to be more cost-effective than PPSV23 vaccination (ICER, $797 per QALY). Sequential PCV13-PPSV23 vaccination was also more cost-effective than PPSV23 for elderly people aged ≥ 65 years. In sensitivity analysis assuming significant PPSV23 effectiveness (50%) against non-bacteremic pneumococcal pneumonia, the PCV13 vaccination strategy was superior to the PPSV23 vaccination strategy in terms of cost-effectiveness. Conclusion The results suggest that PCV13 vaccination is more cost-effective in elderly subjects aged ≥ 65 years compared to the current PPSV23 vaccination strategy. When complete data is obtained in 2018 on the maximal herd effects of childhood PCV13 immunization, the incidence of pneumococcal pneumonia and the cost-effectiveness of vaccination strategies need to be reassessed.

We aimed to determine the initial adherence of HIV cohort patients to ART (antiretroviral therapy), and reasons for non-adherence. Patients who received ART at the time of enrollment in the Korea HIV/AIDS Cohort were included in this study. Treatment adherence was determined at the baseline interview by self-reported questionnaire. Eight-hundred thirty two HIV-infected patients received ART. Of these, 253 (30.4%) patients skipped ART more than once a month. The most common reason of skipping medication was "simply forgot" (60.4%).

Endogenous endophthalmitis secondary to group B Streptococcus (GBS) is extremely rare, particularly in healthy adults. However, the visual prognosis is poor. We report the first South Korean case of GBS infective endocarditis presenting as endogenous endophthalmitis and skin and soft tissue infection. Cultures of blood, vitreous humor, and pus from skin aspirates yielded a penicillin-susceptible serotype V strain of Streptococcus agalactiae. After 6 weeks, the patient completely recovered from GBS infective endocarditis. However, despite early antibiotic treatment and early surgical intervention, the patient's right eye developed phthisis bulbi and was a candidate for evisceration.

We design a compact PCR device based on the host-local structure. The PCR device receives operation commands from the smart phone and sends operation results to the smart phone through Bluetooth communication. The implemented PCR device significantly reduces volume size of existing commercial PCR devices with a similar performance.

Legionella is an important cause of both community-acquired and nosocomial pneumonias. In this chapter, the authors produced 17 monoclonal antibodies (mAbs) against the recombinant PAL (rPAL) cloned from Legionella pneumophila serogroup (sg) 1 and investigated antigenic diversity of the peptidoglycan-associated lipoprotein (PAL) proteins from soluble fractions of 16 Legionella species including 22 serogroups by mAb reactivity patterns in ELISA. Soluble antigens from Legionella strains (L. pneumophila sg 1, 3, 4, 5, and 6; L. annisa; L. dumoffii; L. gormanii; L. jordanis; L. micdadei; L. oakridgensis; L. sainthelensi; L. bozemanii sg 1 and 2; L. longbeachae sg 1 and 2; L. Hackeliae sg 1) were prepared by the method of Berdal et al. The authors concluded that antigenic diversity of a Legionella species–common PAL protein is present among Legionella species and that developing diagnostic agents using a Legionella antigen, even if it is conserved, might be better for separately detecting L. pneumophila species and non-pneumophila Legionella species.

In a study on Legionella species, the authors developed a new immunochromatographic test (ICT), the SD Bioline Legionella antigen test (Standard Diagnostics, Inc., Korea), which uses antibodies specific to the peptidoglycan-associated lipoprotein antigen, and evaluated the performance of the test kit by comparing it with the Binax NOW Legionella urinary antigen test (Binax, Portland, Maine) and Biotest Legionella urine antigen EIA (Biotest AG,Dreieich, Germany). The authors tested urine samples from 99 adult patients with pneumonia. Results of 3 Legionella urinary antigen tests in 11 patients with Legionnaires' disease are provided in this chapter. Comparison of test performance of 3 Legionella urinary antigen assays was performed. Detection of Legionella soluble antigens among those artificially inoculated in normal urine samples are also provided.

The innate immune system has an important function in activation and shaping of the adaptive immune response through the induction of costimulatory molecules and cytokines. The toll-like receptors (TLRs), which have recently been characterized as receptors of innate immunity, are one of the most important pattern recognition receptor families. TLRs recognize various classes of pathogen-associated molecular pattern. A 19-kDa Legionella peptidoglycan-associated lipopro-tein (PAL) is a species-common antigen that successfully induces the PAL-specific immune responses in mice delivered with plasmid DNA3-PAL. The purpose of this study was to determine whether peptidoglycan-associated lipoprotein (PAL) can activate TLRs involved in innate immunity that might be linked to development of specific immune responses. Recombinant-PAL (rPAL) of Legionella pneumophila serogroup 1 was prepared. It also showed that r-PAL-induced cytokine production was inhibited significantly in the presence of TLR2-blocking antibody. These results indicate that the Legionella PAL is likely to activate TLR2-mediated signaling in murine macrophages, and they have important implications for the development of immune responses by Legionella surface antigens.

The purpose of this study was to compare the clinical efficacy and safety of vancomycin to those of teicoplanin for the treatment of adult patients with health care-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) bacteremia. A multicenter observational study was prospectively conducted in 15 teaching hospitals in Korea between February 2010 and July 2011. Adult patients (≥18 years old) with HA-MRSA bacteremia who were initially treated with vancomycin (VAN) ( n = 134) or teicoplanin (TEC) ( n = 56) were enrolled. Clinical and microbiological responses and drug-related adverse events were compared between the two treatment groups using univariate and multivariate logistic regression analyses. The vancomycin and teicoplanin MICs were determined by Etest. The MRSA-related mortality, duration of fever, and duration of MRSA bacteremia in the treatment groups were not significantly different. There was no significant difference in the occurrence of drug-related adverse events. Among the 190 MRSA isolates, the VAN MICs ranged from 0.5 to 2 μg/ml (MIC 50 and MIC 90 , 1.5 μg/ml), and the TEC MIC ranged from 0.5 to 8 μg/ml (MIC 50 , 3 μg/ml; MIC 90 , 6 μg/ml). In multivariate analyses, the antibiotic type (vancomycin or teicoplanin) was not associated with treatment outcomes. This study indicates that teicoplanin is an effective and safe alternative to vancomycin for the treatment of HA-MRSA bacteremia.

In a national sample of high school students, 43 per cent had drunk regularly, 32 per cent had smoked regularly, and 11 per cent had experienced sexual intercourse. Boys were more likely to have experienced these behaviors than girls. Going to school in Seoul, not having two parents in the family, and having an experience of living away from immediate family were associated with higher livelihood of experiencing these behaviors. Students who had friends with sexual experiences were much more likely to experience sex themselves than those without.

To determine prevalence and genetic structures of new serotype 6D strains of pneumococci, we examined isolates from diverse clinical specimens in South Korea during 1991–2008. Fourteen serotype 6D strains accounted for 10.4% of serogroup 6 pneumococci from blood, sputum, nasopharynx, and throat samples. Serotype 6D strains consisted of 3 sequence types.

Pylephlebitis usually occurs secondary to infection in the region drained by the portal venous system. A most common antesecent focus of infection is diverticulitis and the most common blood isolate is E. coli (54%), followed by Proteus mirabilis (23%). Overall mortality is 32% and most of the patients who had died had severe sepsis prior to the initiation of antibiotic therapy. We describe a case of pylephlebitis which had appendicitis and consequent septic thrombosis of the portal vein and its branches, with dissemination of infection to the liver. The patient had recovered due to timely antibiotic treatment alone and resulted in complete resolution. Early diagnosis and treatment are basic to a favorable clinical course.