Coagulase-negative staphylococcal bacteremia: risk factors for mortality and impact of initial appropriate antimicrobial therapy on outcome.

It is uncertain whether an initial inappropriate empirical antibiotic treatment of coagulase-negative staphylococci (CoNS) bacteremia adversely affects the outcome. A retrospective cohort study of CoNS bacteremia was performed at the Dongguk University Ilsan Hospital during a 3-year period. During the study period, 109 patients with CoNS bacteremia were enrolled. The median age of the patients was 72 years and most (96%, 105/109) had one or more comorbid diseases. Among the participants, 29% (32/109) received an appropriate empirical antimicrobial therapy. The 30-day mortality was 24% (26/109) and CoNS bacteremia-related mortality was 14% (15/109). There was no difference in the CoNS bacteremia-related mortality between the group with an inappropriate empirical treatment (13%, 10/77) and that with an appropriate treatment (16%, 5/32) (p = 0.46). In the multivariate analysis using the Cox regression analysis method, Pitt bacteremia scores [hazard ratio (HR) 1.48; 95% confidence interval (CI) 1.09-2.01; p = 0.01] and retention of eradicable focus (HR 5.0; 95% CI 1.39-17.9; p = 0.01) were found to be associated with CoNS bacteremia-related mortality. The results suggest that inappropriate empirical therapy might not necessarily be associated with the 30-day mortality or CoNS bacteremia-related mortality. Conversely, Pitt bacteremia scores and retention of eradicable focus were associated with poor outcomes.

A Fas-associated via death domain promoter polymorphism (rs10898853, -16C/T) as a risk factor for papillary thyroid cancer.

PURPOSE: To determine whether a Fas-associated via death domain (FADD) promoter single-nucleotide polymorphism (SNP) is associated with susceptibility to papillary thyroid cancer (PTC) and clinicopathological features of PTC. METHODS: To identify a possible association with PTC, 94 patients with PTC and 346 healthy controls were recruited. One promoter SNP (rs10898853, -16C/T) was analyzed by direct sequencing. Multiple logistic regression models (co-dominant, dominant, recessive, and log-additive models) were applied, and odds ratios (ORs), 95% confidence intervals (CIs), and p values were calculated. RESULTS: The genotype of the promoter SNP (rs10898853) of FADD was found to be significantly associated with PTC in the co-dominant model 2 (T/T vs. C/C; p = 0.002, OR = 2.80, 95% CI = 1.39-5.65), the recessive model (p = 0.003, OR = 2.21, 95% CI = 1.31-3.71), and the log-additive model (p = 0.002, OR = 1.71, 95% CI = 1.20-2.44). Allele frequency analysis showed that the C allele of rs10898853 was significantly associated with an increased risk of PTC (p = 0.002, OR = 1.67, 95% CI = 1.21-2.32). CONCLUSIONS: Our results suggest that the FADD promoter polymorphism is associated with susceptibility to PTC.

Effects of injection of acetic acid and propionic acid for total phosphorus removal at high temperature in enhanced biological phosphorus removal process.

In summer, wastewater treatment plant total phosphorus (TP) removal efficiency is low in South Korea. The reason is because of high temperatures or significant fluctuation of inflow characteristics caused by frequent rainfall. Hence, this study tried to raise TP removal efficiency by injecting fixed external carbon sources in real sewage. Polyphosphate accumulating organisms (PAOs) and glycogen accumulating organisms (GAOs) compete to occupy microorganisms at high temperature. Propionate is known to restrain GAOs. Thus, acetate and propionate were chosen as the external carbon source in this study to find out the suitable volume and ratio of carbon source which ensured the dominance of PAOs. An external carbon source was supplied in the anaerobic reactor of the biological phosphorus removal process at high temperature (above 25 °C). TP removal efficiency was improved by injecting an external carbon source compared to that without an external carbon source. Also, it remained relatively stable when injecting an external carbon source, despite the variation in temperature. TP removal efficiency was the highest when injecting acetate and propionate in the proportion of 2:1 (total concentration as chemical oxygen demand (COD) is 12 mg/L in influent).

Percolated pore networks of oxygen plasma-activated multi-walled carbon nanotubes for fast response, high sensitivity capacitive humidity sensors.

We report on the preparation of capacitive-type relative humidity sensors incorporating plasma-activated multi-wall carbon nanotube (p-MWCNT) electrodes and on their performance compared with existing commercial technology. Highly open porous conductive electrodes, which are almost impossible to obtain with conventional metal electrodes, are fabricated by spray-depositing MWCNT networks on a polyimide layer. Oxygen plasma activation of the MWCNTs is also explored to improve the water adsorption of the MWCNT films, by introducing oxygen-containing functional groups on the CNT surface. Polyimide humidity sensors with optimized p-MWCNT network electrodes exhibit exceptionally fast response times (1.5 for adsorption and 2 s for desorption) and high sensitivity (0.75 pF/% RH). These results may be partially due to their percolated pore structure being more accessible for water molecules, expending the diffusion of moisture to the polyimide sensing film, and partially due to the oxygenated surface of p-MWCNT films, allocating more locations for adsorption or attraction of water molecules to contribute to the sensitivity.

Interleukin 22 polymorphisms and papillary thyroid cancer.

BACKGROUND: IL22RA1 (Interleukin 22 receptor-alpha 1), a member of the class II cytokine receptor family, mediates diverse biologic activities and appears to be important in pathogen defense, wound healing, and tissue reorganization. Polymorphisms in genes encoding inflammatory cytokines are associated with increased cancer risk. AIM: The aim of this study was to evaluate the association between the single nucleotide polymorphisms (SNP) in the IL22 and IL22RA1 and papillary thyroid cancer (PTC), and to assess the relationship between the SNP in the IL22 and IL22RA1 and the clinical parameters of PTC. MATERIAL AND METHODS: Study enrolled experimental group of 94 PTC patients and 213 controls. PTC patients were grouped and compared for clinical PTC parameters. One promoter SNP of IL22, -429C/T (rs2227485), and one SNP of IL22RA1, Arg518Gly (rs3795299) were analyzed using direct sequencing. Genetic data were analyzed using Helixtree, SNPAnalyzer Pro, SNPStats, and Haploview. RESULTS: A SNP in IL22 (rs2227485) was significantly associated with PTC (codominant2 model [C/C vs T/T], odds ratio (OR) 2.39, 95% confidence interval (CI) 1.21-4.71, p=0.012; dominant model, OR 1.89, 95% CI 1.08-3.31, p=0.022). The allele T frequency of rs2227485 in IL22 was also associated with PTC (OR 1.59, 95% CI 1.13-2.25, p=0.009). According to clinical parameters, rs2227485 of IL22 was associated with number of cancers (dominant model, OR 3.03, 95% CI 1.02-9.01, p=0.035). By haplotype analysis, TG was associated with PTC (codominant model, OR 1.52, 95% CI 1.07-2.16, p=0.019; dominant model, OR 1.91, 95% CI 1.13- 3.24, p=0.015). Genotype and allele analysis of rs3795299 in IL22RA1 showed no significant differences between PTC patients and controls. CONCLUSION: The rs2227485 SNP in IL22 might be associated with the risk and the multifocality of PTC.

Association between a promoter polymorphism (rs2192752, -1028A/C) of interleukin 1 receptor, type I (IL1R1) and location of papillary thyroid carcinoma in a Korean population.

The interleukin 1 receptor, type I (IL1R1) is important in the pathogenesis of cancer. We investigated whether single nucleotide polymorphisms (SNPs) of IL1R1 contribute to the development of papillary thyroid carcinoma (PTC), in addition to the clinicopathological features such as the size, number, location, extrathyroidal invasion and metastasis of PTC. Three promoter SNPs (rs949963 -615G/A, rs2192752 -1028A/C and rs3917225 -1099A/G) in IL1R1 were genotyped using direct sequencing in 118 patients with PTC and 347 controls. The odds ratio (OR), 95% confidence interval (CI) and P value were analysed using SNPStats and SNPAnalyzer Pro. For the exact results, Fisher's exact test and Bonferroni correction (P(c)) were performed. The three promoter SNPs of IL1R1 were not associated with PTC development. For the clinicopathological features of PTC, rs2192752 was associated with location (one lobe versus both lobes): dominant model, OR = 3.11, 95% CI = 1.39-6.96, P(c) = 0.015; log-additive model, OR = 2.79, 95% CI = 1.38-5.66, P(c) = 0.0087. The C allele frequency of rs2192752 was higher in the both lobes group (28.0%) than the one lobe group (12.3%) (OR = 2.77, 95% CI = 1.40-5.48, P(c) = 0.009). However, rs949963 and rs3917225 were not correlated with clinicopathological features including location of PTC. The IL1R1 promoter SNP rs2192752 may contribute to the location of PTC, and the C allele of rs2192752 may be a risk factor for the development of PTC in both lobes.

Use of antimicrobial agents in aquaculture.

The aquaculture industry has grown dramatically, and plays an important role in the world's food supply chain. Antimicrobial resistance in bacteria associated with food animals receives much attention, and drug use in aquaculture is also an important issue. There are many differences between aquatic and terrestrial management systems, such as the methods used for administration of drugs. Unique problems are related to the application of drugs in aquatic environments. Residual drugs in fish products can affect people who consume them, and antimicrobials released into aquatic environments can select for resistant bacteria. Moreover, these antimicrobial-resistant bacteria, or their resistance genes, can be transferred to humans. To decrease the risks associated with the use of antimicrobials, various regulations have been developed. In addition, it is necessary to prevent bacterial diseases in aquatic animals by vaccination, to improve culture systems, and to monitor the amount of antimicrobial drugs used and the prevalence of antimicrobial-resistant bacteria.

Analysis of etching mechanism and etched slope control of silicon for nanoimprinting lithography.

In the nanoimprint lithography (NIL) process, profile control of imprint masters is a very important task. Therefore, we attempted to control the etched slope of imprint masters as a function of adding O2 to CF4 plasma. Etched profile mechanisms and relationships between the etch kinetics and plasma chemistry were explored using zero-dimensional-based modeling. O2 flow rate increased to 24 sccm, the Si etch rate increased in the range of 186-393 nm/min, while the etch rate rapidly decreased as the O2 flow rate increases beyond 24 sccm. Meanwhile, change in the etch rate of SiO2 followed a similar tendency as the etch rate of Si as a function of O2 flow rate in the CF4/O2 mixing gases. The Si and SiO2 etch rate were expected to be closely dependent on the F radical intensity in CF4/O2 mixing gases. Moreover, the results of simulated normalized lateral etch critical dimension (NLECD) are in agreement with the measured NLECD as a function of O2 flow rate in the CF4/O2 mixing gases.

Mathematical models for biomass in membrane-BNR process for wastewater treatment.

The equation of biomass is related to the mass-balance equation of substrate. This equation of substrate is expressed according to a model using the Monod equation, which indicates some limits for calculating the amounts of VSS in the MBR process. Some degradation of biomass which is caused by long SRT might result in the generation of substrate based on COD. Research was conducted by lab-scale tests with two membrane-BNR (Biological Nutrients Removal) processes. These were composed of multi-reactors as anaerobic, anoxic, aerobic tank and oxygen exhauster. The aerobic tank was also divided into 3 reactors, which were oxic for nitrification, oxic-media containing fluidized sponge typed media for simultaneous nitrification and denitrification, and oxic-membrane for submerged membrane. This membrane-BNR process could remove most of the organics, suspended solids and nutrient substances like nitrogen thus satisfying the reuse guidelines issued by the Korean Ministry of Environment. The value measured of VSS (X(v)) through the experiment with SRT of 35 days was similar to the biomass using the conventional equation while the one with SRT of 60 days was close to the concentration of VSS calculated by a revised equation which considered the biomass degraded with long SRT.

Economical and technical efficiencies evaluation of full scale piggery wastewater treatment BNR plants.

A method evaluating the economic efficiency of piggery waste treatment plant based on kinetics for nitrogen removal performances is executed in this study and five full scale plants were evaluated, monitored intensively during one year under steady-state conditions. The performance data from those surveyed plants were recalculated by first-order kinetic equation instead of the Monod's equation, and the nitrogen removal kinetics related with COD/TKN ratios. Two plants adapting two extreme strategies for pre treatment, 'excess phase separation', and 'minimum phase separation', were evaluated by the assessment of life cycle cost (LCC). Although the compared two plants use an opposite strategy to each other, similar evaluation results are deduced by nitrogen removal efficiencies and operational and construction costs. But the proportions of constituent elements are as different as two opposite strategies, so electrical and construction costs are inversely proportional to chemical costs and operational costs respectively.

Kidney Transplantation Using Expanded-Criteria Deceased Donors: A Comparison With Ideal Deceased Donors and Non-Expanded-Criteria Deceased Donors.

PURPOSE: The use of expanded-criteria deceased-donor (ECD) kidneys must be evaluated within the objective perspective of critical organ shortage and graft function and survival. In this study, we aimed to compare the clinical outcomes of ECD reliance with concurrent use of ideal-criteria deceased donors (IDDs) and non-ECDs in adult renal transplantation. METHODS: Between February 2000 and December 2015, we analyzed 405 deceased-donor renal transplants, specifically 129 grafts (31.9%) from ECDs, 233 grafts (57.5%) from non-ECDs, and 43 grafts (10.6%) from IDDs. ECDs were classified according to the United Network for Organ Sharing guidelines, while an IDD was defined as a younger person (10-39 years of age) with no medical risk factors who died from a traumatic head injury. Donor and recipient risk factors were separately analyzed and correlated with recipient graft function, and survival was evaluated. RESULTS: ECDs were older (56.8 ± 6.3 years); showed increased incidence of hypertension, diabetes, and cerebrovascular brain death; and had a higher pre-retrieval serum creatinine level than the other groups. ECD kidney recipients were also older (50.6 ± 9.8 years), had a shorter waiting time (P = .031), and demonstrated a low frequency of re-transplantation (P = .028). Long-term renal function followed longitudinally was lower in ECD kidney recipients until five years after transplantation, while the glomerular filtration rate (GFR) level at 7 and 10 years did not differ significantly among the groups (P = .074 and .262, respectively). There were no significant differences in terms of graft survival (P = .394) or patient survival (P = .737) among the groups. CONCLUSIONS: Although the long-term renal function followed longitudinally was lower in ECD kidney recipients, the use of renal grafts from ECDs is an acceptable method to resolve the disparity of critical organ shortage. However, the classification of the high-risk group should be updated with consideration given to differences in regional characteristics.

Posterior circulation ischemic stroke in Korean population.

To understand the characteristics of posterior circulation ischemic stroke (PCS) in the Korean population better, we retrospectively reviewed the data from the Hallym Stroke Registry (HSR). We analyzed the demographic features, risk factors, stroke subtypes, lesion distributions and clinical outcomes of 591 consecutive patients with PCS, enrolled in HSR between January 1996 and July 2002. PCS was 39.8% of all ischemic strokes. Mean age of PCS patients was 63.4 years and 55.7% were men. Hypertension was the most common risk factor (69.9%). However, potential cardioembolic sources were found only in 11.0%. The most frequent stroke subtype was large artery disease (50.0%), followed by small vessel disease (33.8%). Only 5.2% of patients were classified as affected with cardioembolism. The most common location of infarcts was in the middle territory (36.5%), followed by distal (28.1%), proximal (19.0%), and multiple territories (16.4%). The hospital mortality rate (4.1%) and discharge outcome of PCS were comparable with those of the anterior circulation stroke (ACS). In conclusion, the etiology and lesion topography of PCS in the Korean population appeared to be different from those of the Caucasians.

Oncological and functional results after the surgical treatment of parotid cancer.

The objective of this study was to analyze the oncological and functional outcomes after the surgical treatment of parotid cancer. We reviewed 80 primary parotid carcinomas retrospectively. A superficial parotidectomy was performed in 10 patients; 27 patients underwent total parotidectomy and 43 patients underwent radical parotidectomy. A facial-facial nerve anastomosis was chosen for the facial nerve reconstruction in eight patients, while an interpositional graft was selected in 24 patients. The overall N-positive rate of pathology was 21.3%. The rate of occult metastasis was 8.1%. High-grade carcinoma and lymphovascular emboli were independent factors for nodal metastasis. The 5-year disease-free survival and overall survival rates were 79.7% and 78.8%, respectively. Preoperative facial nerve palsy and extraparenchymal invasion were the independent factors associated with poor disease-free survival. Of the 41 patients in the facial nerve preservation group, 13 (31.7%) had transient facial nerve paresis. In the facial nerve sacrifice group of 39 cases, (sub)total recovery (House-Brackmann grade I/II) occurred in 14 (35.9%), partial recovery (House-Brackmann grade III/IV) in 13 (33.3%), and no recovery (House-Brackmann grade V) in 12 (30.8%). Facial nerve palsy upon presentation and extraparenchymal invasion indicate a grave prognosis. Facial nerve function after proper reconstruction is tolerable.

Papillomas of the tracheobronchial tree with malignant degeneration.

Papillomas are rare tumors of the respiratory tract, which are usually considered benign. We studied a male patient with adult onset of squamous papillomatosis involving both the trachea and the bronchi, with malignant degeneration. When we obtained specimens bronchoscopically, only the bronchial lesions showed carcinomatous changes. Thoracotomy demonstrated carcinoma in the tracheal lesion as well. We conclude that transbronchoscopic biopsy may be inadequate in the evaluation of papillomatosis.

Metastatic myocardial abscess due to group F streptococci.

Remote myocardial infarction in a 60-year-old, blind diabetic man, was complicated by suppuration within the old fibrotic area by a group F streptococcus. Osteomyelitis of the fifth (right) metatarsal bone served as the primary focus. A review of the literature uncovered no findings which could help to predict the onset of abscess formation within a myocardial infarction. Although this complication occurs rarely, the entity should be kept in mind in patients with infarcts and a remote source of infection.

Suppressive activity of a fermented grain food product on dextran sulfate sodium-induced experimental colitis in mice.

Oxidative stress has been shown to play pivotal roles in the onset of inflammatory bowel disease. We evaluated the effects of a dietary anti-oxidant, Antioxidant Biofactor (AOB), a processed grain food, on dextran sulfate sodium (DSS)-induced colitis in mice. Female ICR mice were fed a diet containing 0.1% or 1% AOB for 2 weeks, during which they were given 5% DSS in drinking water for the latter 1 week to induce colitis. A diet containing 1% AOB, but not that with 0.1% AOB, attenuated DSS-induced body weight loss and colon shortening (each, P < 0.05), and dramatically improved colitis histologic scores. In addition, DSS-induced increases in colonic mucosal IL-1beta, but not TNF-alpha, protein levels were significantly abrogated in 1% AOB-fed mice (P < 0.05). Further, 1% dietary AOB abolished the expression of IL-1beta mRNA levels in colonic mucosa (P < 0.01). Our results suggest that AOB is effective for the prevention of DSS-induced colitis in mice.

Liddle's syndrome: a report in a middle-aged woman.

A 54-year-old woman with diabetes mellitus was hospitalized with generalized edema and weakness. She was also found to have hypertension, hypokalemia and metabolic alkalosis. Detailed examination showed subnormal plasma renin activity and plasma aldosterone concentration. Adrenal CT scanning revealed no adrenal tumor. A successful treatment with amiloride established the diagnosis of Liddle's syndrome for the patient. Liddle's syndrome, a rare hereditary disease usually found in young patients, should be considered in the differential diagnosis of hypertension even in elderly individuals.

Antibodies to human T-cell lymphotropic virus type I (HTLV-I) by particle agglutination (PA) test in Korean blood donors.

HTLV-I infection is a recently recognized disease entity that is common in some tropical and subtropical areas, including the southwestern district of Japan. Despite the geographical proximity and frequent cultural exchanges between Korea and Japan, it is understood that Korea is not an endemic area and HTLV-I-associated illnesses are very rare in Korea. This study was designed to evaluate the positive rate of anti-HTLV-I antibodies in Korean blood donors and its regional distribution. Sera were obtained from blood donors from various districts around Korea. Anti-HTLV-I antibodies were detected by using the microtiter particle agglutination test employing an indirect agglutination technique. A total of 9,281 donors were tested and 12 donors (0.13%) were positive for anti-HTLV-I antibodies, 10 (0.11%) out of 8,845 males and 2 (0.46%) out of 436 females, with relative female predominance. A relatively high incidence of anti-HTLV-I positive donors was observed in Cheju Island (0.80%), Kyungnam (0.31%), and Chonnam (0.15%). In conclusion, the positive rate of anti-HTLV-I antibodies seemed to be very low in Korea, but the highest positive rate of anti-HTLV-I antibodies was noticed on Cheju Island, warranting further research for confirmation.

Gastroesophageal reflux disease in CAPD patients.

Upper gastrointestinal (GI) symptoms are frequently observed in continuous ambulatory peritoneal dialysis (CAPD) patients. We conducted esophageal manometry and 24-hour esophageal pH monitoring in 4 CAPD patients (Group I) who had upper GI symptoms such as nausea and vomiting and compared them with 9 patients (Group II) who did not. The mean age in Group I was 48.5 +/- 13.7 years, and the male-to-female ratio was 1:3. One patient was diabetic. There were no significant differences in clinical and biochemical data between the two groups. Comparing the results of esophageal manometry, supine lower esophageal sphincter pressure (LESP) at 2000 mL of infused dialysate was significantly lower in Group I than in Group II (23.2 +/- 4.4 vs 31.2 7.1 mmHg, P < 0.05), but supine LESPs at empty state and sitting LESPs were not different. Group I had a significantly higher total number of reflux episodes (89.0 +/- 16.5 vs 26.5 +/- 19.4, P < 0.05), number of reflux episodes longer than 5 minutes (2.3 +/- 2.6 vs 0.3 +/- 0.5, P < 0.05), total time of pH < 4.0 (75.5 +/- 55.5 vs 11.0 +/- 6.8, P < 0.05), and total reflux score (19.7 +/- 10.2 vs 4.2 +/- 2.3, P < 0.05) in 24-hour esophageal pH monitoring. Three of 4 Group I patients met the criteria for abnormal gastroesophageal reflux set by the DeMeester scoring system. CAPD patients with upper GI symptoms such as nausea, vomiting, and epigastric discomfort should be evaluated for gastroesophageal reflux disease with esophageal manometry and pH monitoring.

Long-term outcomes of kidney transplantation from expanded criteria deceased donors at a single center: comparison with standard criteria deceased donors.

Our objective was to compare the clinical outcomes of adult kidney transplants from expanded criteria deceased donors (ECD) with those from concurrent standard criteria deceased donors (SCD). Between January 2000 and December 2011, we transplanted 195 deceased donor renal transplants into adult recipients, including 31 grafts (15.9%) from ECDs and 164 grafts (84.1%) from SCDs. ECDs were classified using the United Network for Organ Sharing (UNOS) definitions. Donor and recipient risk factors were analyzed separately and their correlation with recipient graft function and survival was evaluated (minimum 6-month follow-up). ECDs were older (56.8 ± 6.3 years), showed an increased incidence of hypertension, diabetes, and cerebrovascular brain death, and had a higher preretrieval serum creatinine level than SCDs. ECD kidney recipients had a shorter waiting time (P = .019) but other baseline characteristics (age, gender, body mass index [BMI], cause of end-stage renal disease, type of renal replacement therapy, incidence of diabetes and hypertension, number of HLA antigen mismatches, positivity for panel-reactive antigen, and cold ischemic time) were not significantly different from those of SCD kidney recipients. Mean glomerular filtration rate (GFR) at 1 month, 6 months, 1 year, and 3 years after transplantation was significantly lower in recipients of ECD transplants than recipients of SCD transplants, but the GFR level at 5 and 10 years was not significantly different between ECD and SCD recipient groups (P = .134 and .702, respectively). Incidence of acute rejection episodes and surgical complications did not differ significantly between the 2 recipient groups, but the incidence of delayed graft function (DGF) and infectious complications was higher in ECD kidney recipients than SCD kidney recipients (P = .007 and P = .008, respectively). Actual patient and graft survival rates were similar between the 2 recipient groups with a mean follow-up of 43 months. There were no significant differences in graft survival (P = .111) or patient survival (P = .562) between the 2 groups. Although intermediate-term renal function followed longitudinally was better in SCD kidney recipients, graft and patient survival of ECD kidney recipients were comparable with those of SCD kidney recipients. In conclusion, use of renal grafts from ECDs is a feasible approach to address the critical organ shortage.