Characteristics of a large latent tuberculous infection screening programme using QuantiFERON®-TB Gold in Korea.

BACKGROUND: As mentioned in the 'Action Strategy for TB Safe Korea' in March 2017, almost 2 million Koreans were screened for latent tuberculous infection (LTBI) in 2017. As a preliminary step, the Korean Institute of Tuberculosis (KIT) screened 23 824 individuals from various population groups. The present study aimed to characterise the data collected from the screening programme using the QuantiFERON®-TB Gold In-Tube (QFT) assay. METHODS: Interferon-gamma release assays were performed using the manual QFT or automated DS2 instruments. Statistical analyses were performed using Stata software. Turnaround time (TAT) was defined as the average time required from submission of whole blood samples by each regional laboratory to the reporting of results by the central laboratory. RESULTS: Seventeen individuals (0.1%) had indeterminate results on repeat testing, 4519 (18.98%) screened positive and 19 288 (81.0%) were screen-negative. The group of social welfare workers had the highest positivity rate, at 27.2%. Of the 11 regions in Korea, the Gyeonggi Region had the highest positivity rate, at 25.8%. The overall mean ± standard deviation for TAT was 3.05 ± 1.66. CONCLUSION: These findings provide information on LTBI prevalence in a Korean population, and will be helpful in implementing the LTBI screening strategy for those participating in the Action Strategy for TB Safe Korea.

Measurement of body joint angles for physical therapy based on mean shift tracking using two low cost Kinect images.

Range of motion (ROM) is commonly used to assess a patient's joint function in physical therapy. Because motion capture systems are generally very expensive, physical therapists mostly use simple rulers to measure patients' joint angles in clinical diagnosis, which will suffer from low accuracy, low reliability, and subjective. In this study we used color and depth image feature from two sets of low-cost Microsoft Kinect to reconstruct 3D joint positions, and then calculate moveable joint angles to assess the ROM. A Gaussian background model is first used to segment the human body from the depth images. The 3D coordinates of the joints are reconstructed from both color and depth images. To track the location of joints throughout the sequence more precisely, we adopt the mean shift algorithm to find out the center of voxels upon the joints. The two sets of Kinect are placed three meters away from each other and facing to the subject. The joint moveable angles and the motion data are calculated from the position of joints frame by frame. To verify the results of our system, we take the results from a motion capture system called VICON as golden standard. Our 150 test results showed that the deviation of joint moveable angles between those obtained by VICON and our system is about 4 to 8 degree in six different upper limb exercises, which are acceptable in clinical environment.

Quantitative assessment of renal arterial occlusion in a porcine model using spatial frequency domain imaging.

We present the results of a feasibility study with spatial frequency domain imaging (SFDI) to produce quantitative measurements of optical property and chromophore concentration maps of three porcine kidneys utilizing a renal occlusion model at the near-infrared wavelengths of 658, 730, and 850 nm. Using SFDI, we examined the dynamics of absolute oxygen saturation (StO2). The mean StO2 for the kidneys varied from approximately 60% before occlusion, to 20% during occlusion, to 55% after reperfusion. We also present, for the first time to the best of our knowledge, reduced scattering coefficient (µ(s)') maps of the kidney during occlusion. We observed a substantial decrease in the wavelength dependence of scattering (i.e., scattering power) in the three kidneys, with a mean decrease of 18%±2.6%, which is indicative of an increase in scatterer size, and is likely due to tissue changes such as edema that follow from occlusion and inflammation.

Incidence and management of postoperative abdominal bleeding after liver transplantation.

PURPOSE: To assess the incidence and management of postoperative abdominal bleeding after orthotopic liver transplantation (OLT) and to identify risk factors for abdominal bleeding. METHODS: We retrospectively reviewed the medical records of 1039 patients who underwent OLT at our institution from January 2008 to December 2010 seeking to identify subjects with posttransplantation abdominal bleeding, defined as any hemorrhage requiring radiologic intervention or laparotomy within the first month. RESULTS: Among the 1039 patients, 94 (9%) showed abdominal bleeding, occurring at a mean of 6.1 days (range, day 1 to 21 days). Active bleeding was controlled by endovascular interventional techniques (n = 37; 39%), by surgical ligation or vascular reconstruction (n = 43; 46%), or by sequential combinations of endovascular intervention and surgery (n = 14; 15%). The most frequent bleeding sites for radiologic intervention were the right inferior phrenic artery (n = 14), right and left epigastric arteries (n = 7), intercostal artery (n = 5) and right renal capsular artery (n = 4). The most frequent bleeding sites requiring laparotomy were the hepatic artery (n = 9), diaphragm (n = 8), inferior vena cava (n = 5), abdominal drain insertion site (n = 4), portal vein anastomosis site (n = 4), abdominal wall (n = 3), liver graft cut surface (n = 3), hilar plate (n = 3), and greater omentum (n = 3). Bleeding episodes were associated with greater patient age and increased intraoperative blood loss. CONCLUSIONS: The risk of bleeding from coagulopathy and iatrogenic injury is high during the early posttransplantation period. This risk of bleeding can be minimized by meticulous surgical dissection and bleeding control.

Quantitative assessment of cerebral ventricular volumes in chronic fatigue syndrome.

Previous qualitative volumetric assessment of lateral ventricular enlargement in chronic fatigue syndrome (CFS) has provided evidence for subtle structural changes in the brains of some individuals with CFS. The aim of this pilot study was to determine whether a more sensitive quantitative assessment of the lateral ventricular system would support the previous qualitative findings. In this study, we compared the total lateral ventricular volume, as well as the right and left hemisphere subcomponents in 28 participants with CFS and 15 controls. Ventricular volumes in the CFS group were larger than in control groups, a difference that approached statistical significance. Group differences in ventricular asymmetry were not observed. The results of this study provide further evidence of subtle pathophysiological changes in the brains of participants with CFS.

Cataract in leprosy patients: cataract surgical coverage, barriers to acceptance of surgery, and outcome of surgery in a population based survey in Korea.

BACKGROUND/AIMS: Cataract is the leading cause of blindness in leprosy patients. There is no population based information on the cataract surgical coverage, barriers to use of surgical services, and outcome of surgery in these patients. We sought to determine these measures of cataract programme effectiveness in a cured leprosy population in South Korea. METHODS: The population consisted of residents of six leprosy resettlement villages in central South Korea. All residents were invited to participate in a study of eye disease and interviewed regarding use of surgical services and reasons for not using these services. RESULTS: The cataract surgical coverage in this population was 55.4% when <6/18 was used as the cut off and increased to 78.3% when the cut off was <6/60. Barriers reported by patients included being told by the doctor that the cataract was not mature and a perception by the patient that there was no need for surgery. Among patients who had aphakic surgery, 71% were still blind in the operative eye while among patients who had pseudophakic surgery, 14% were still blind (presenting vision). Blindness in pseudophakic patients could be reduced to 3% with spectacle correction. CONCLUSION: Cataract prevalence in leprosy patients will increase as life expectancy continues to increase. Leprosy control programmes will need to develop activities aimed at reducing the burden of cataract. Recommendations include establishing collaborative agreements with ophthalmological services to provide high quality IOL surgery to these patients, training of health staff to identify and refer patients in need of surgery, monitoring the uptake of cataract surgery among patients needing services, and monitoring the outcome of surgery to improve refractive outcome.

Clinical improvement and immunohistochemical findings in severe atopic dermatitis treated with interferon gamma.

BACKGROUND: Several clinical studies have focused on the therapeutic effects of interferon gamma (IFN-gamma) in patients with severe atopic dermatitis (AD), although the dosage of recombinant IFN-gamma (rIFN-gamma), therapeutic schedule, and the degree of clinical improvement were different among studies. Although the exact mechanism of action of IFN-gamma therapy in AD is not clear, the beneficial effects of IFN-gamma have been attributed mainly to an immunomodulating effect on the expression of certain immunologic markers. OBJECTIVE: Our purpose was to study the therapeutic effect of two different dosages of rIFN-gamma on AD and to investigate the change of lesional expression of infiltrating inflammatory cell markers associated with rIFN-gamma therapeutic efficacy. METHODS: Fifty-one patients with severe recalcitrant AD were treated with rIFN-gamma. Twenty patients were treated with 0.5 x 10(6) IU/m(2) of rIFN-gamma (low-dose [LD] group); 21 patients received 1.5 x 10(6) IU/m(2) of rIFN-gamma (high-dose [HD] group); and 10 patients received placebo. The patients were injected subcutaneously 3 times a week for 12 weeks. Immunohistochemical study was performed in 20 patients of the HD group in the initial visit and after completion of rIFN-gamma therapy with a panel of 14 monoclonal antibodies as markers of inflammatory cells and cytokines. RESULTS: The disease severity of the 2 groups treated with rIFN-gamma was reduced significantly at the end of treatment compared with that of the placebo group (P<.05). More rapid clinical improvement and more effective treatment outcome were seen in the HD group than in the LD group for the initial 6-week treatment period; however, the clinical improvement in both of the treated groups was stable and maintained after week 8 of treatment. Immunohistochemical findings showed statistically significant reduction in the lesional expression of CD25 and EG2 cells that infiltrated into skin after rIFN-gamma therapy. CONCLUSION: This study demonstrated that rIFN-gamma therapy for AD is safe and effective. In the early phase of therapy, a higher dosage of rIFN-gamma is more effective; and for the maintenance of clinical improvement, a lower dosage of rIFN-gamma is recommended when high cost and effectiveness of rIFN-gamma are considered. The therapeutic efficacy of rIFN-gamma in AD might be in part related to the decreased number of CD25(+) and EG2(+) inflammatory cells infiltrated into skin.

A second look at the embryotoxicity of hydrosalpingeal fluid: an in-vitro assessment in a murine model.

The purpose of this study was to evaluate whether hydrosalpingeal fluid (HSF) is toxic to the mouse embryo as assessed by the blastocyst development rate (BDR) and by cell counting in vitro. HSF was collected from nine patients undergoing salpingoneostomy to correct hydrosalpinx. Two-cell embryos were obtained from superovulated ICR mice. T6 medium and T6 + 0.4% bovine serum albumin (BSA) were used as control media. T6 medium containing 10% or 50% HSF and 100% HSF from each patient were used as test media. Nine to 15 embryos were cultured in microdrops prepared from each of these media. The BDR was examined after 72 h of culture in these media. To assess the total cell number within each blastocyst, the blastocysts were fixed and stained with Hoechst 33342 to facilitate cell counting. The BDR was affected adversely only by 100% HSF and not in media containing 10% or 50% HSF. The mean BDR using T6 medium and T6 + BSA were 88.7% and 85.3%, respectively. The mean BDR using media containing 10% HSF or 50% HSF were 90.0% and 89.4%, respectively. Mean BDR using 100% HSF was 75.2% (P < 0.05). The overall mean cell counts (+/- SEM) using T6 medium and T6 + BSA were 86.9+/-3.2 and 91.0+/-3.8 respectively. Mean cells counts were decreased significantly only in blastocysts cultured in 100% HSF (63.3+/-4.6; P < 0.01) but not in blastocysts cultured in 10% or 50% HSF (90.8+/-4.2 and 81.9+/-6.1 respectively). Thus, it is concluded that HSF has no embryotoxic effect but has a mildly negative effect on embryonic growth and development.

[Development in the National Hospice Care Service in Korea].

The urgent needs to establish hospice care systems in Korea arise from the following reasons: (1) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e.g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accommodate other medical insurance beneficiaries: (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life: (6) medical and nursing care of AIDS patient in terminal stage: (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage, grouped in hospice and non-hospice care patients, reveal what they want visiting nursing care to help their pain control, psychological, social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains, the non-hospice care patients, in addition to their desire for pain control, demanded more psychological, social and spiritual helps as well. The results of this research could be utilized to (1) define the standard of hospice care, (2) provide the guidance for hospice medical care costs, (3) establish the database of hospice care systems, (4) develop softwares, (5) build communication network through Medinet, and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy, nursing care, and social welfare programs.

Rural elderly individuals. Strategies for delivery of nursing care.

This article has presented nursing care strategies for rural elderly persons at the individual and community level. The approach for the strategies was accomplished through presentation of Lawton and Nahemow's Ecological Model of Adaptation and Aging. Competencies of older rural adults and their physical, personal, and social environment were explored using current available literature. Nurses are and can play a key role in maintaining and promoting the health of rural elderly persons.

Relationship of hardiness and current life events to perceived health in rural adults.

The purpose of this descriptive study was to examine the relationship of hardiness and current life events to perceived health in rural adults. Instruments used included Kobasa's (1982) Hardiness Scale, SRLE (Holmes & Rahe, 1967), and Engel's (1984) Perceived Health Status. Study results were based on 162 participants responding to a mailed questionnaire. The typical respondent was a 55-year-old married male who lived on a farm or ranch. Participants with higher levels of hardiness demonstrated a better perception of their mental and social health but not physical health. The study findings did not support the buffering effects of hardiness in the presence of greater amounts of stress.

Comparison of simultaneously obtained objective and subjective measurements of fixation disparity.

Simultaneous objective (based on binocular eye movement record) and subjective (nonius-line displacement) measurements of horizontal and vertical fixation disparity were carried out in order to evaluate the reliability of the nonius-line method of measuring ocular deviation. Significant differences were found between the subjective and objective measurements. These differences indicate that the nonius-line method is unreliable for the measurement of ocular deviation or fusional status.