Background: Although small- and medium-sized hospitals comprise most healthcare providers in South Korea, data on antibiotic usage is limited in these facilities. We evaluated the pattern of antibiotic usage and its appropriateness in hospitals with <400 beds in South Korea. Methods: A multicenter retrospective study was conducted in 10 hospitals (6 long-term care hospitals, 3 acute-care hospitals, and 1 orthopedic hospital), with <400 beds in South Korea. We analyzed patterns of antibiotic prescription and their appropriateness in the participating hospitals. Data on the monthly antibiotic prescriptions and patient days for hospitalized patients were collected using electronic databases from each hospital. To avoid the effect of the COVID-19 pandemic, data were collected from January to December 2019. For the evaluation of the appropriateness of the prescription, 25 patients under antibiotic therapy were randomly selected at each hospital over 2 separate periods. Due to the heterogeneity of their characteristics, the orthopedics hospital was excluded from the analysis. The collected data were reviewed, and the appropriateness of antibiotic prescriptions was evaluated by 5 specialists in infectious diseases (adult and pediatric). Data from 2 hospitals were assigned to each specialist. The appropriateness of antibiotic prescriptions was evaluated from 3 aspects: route of administration, dose, and class. If the 3 aspects were ‘optimal,’ the prescription was considered ‘optimal.’ If only the route was ‘optimal,’ and the dose and/or class was ‘suboptimal,’ but not ‘inappropriate,’ it was considered ‘suboptimal.’ If even 1 aspect was ‘inappropriate,’ it was classified as ‘inappropriate.’ Results: The most commonly prescribed antibiotics in long-term care hospitals was fluoroquinolone, followed by β-lactam/β-lactamase inhibitor (antipseudomonal). In acute-care hospitals, these were third-generation cephalosporin, followed by first-generation cephalosporin and second-generation cephalosporin. The major antibiotics that were prescribed in the orthopedics hospital was first-generation cephalosporin. Only 2.3% of the antibiotics were administered inappropriately. In comparison, 15.3% of patients were prescribed an inappropriate dose. The proportion of inappropriate antibiotic prescriptions was 30.6% of the total antibiotic prescriptions. Conclusions: The antibiotic usage patterns vary between small- and medium-sized hospitals in South Korea. The proportion of inappropriate prescriptions exceeded 30% of the total antibiotic prescriptions.

Funding: None

Disclosures: None

The explosive outbreak of COVID-19 led to a shortage of medical resources, including isolation rooms in hospitals, healthcare workers (HCWs) and personal protective equipment. Here, we constructed a new model, non-contact community treatment centres to monitor and quarantine asymptomatic and mildly symptomatic COVID-19 patients who recorded their own vital signs using a smartphone application. This new model in Korea is useful to overcome shortages of medical resources and to minimise the risk of infection transmission to HCWs.

To evaluate the appropriateness of the screening strategy for healthcare personnel (HCP) during a hospital-associated Middle East Respiratory Syndrome (MERS) outbreak, we performed a serologic investigation in 189 rRT-PCR–negative HCP exposed and assigned to MERS patients. Although 20%–25% of HCP experienced MERS-like symptoms, none of them showed seroconversion by plaque reduction neutralization test (PRNT).

Infect Control Hosp Epidemiol 2017;38:234–238

The HoDoo English game was developed to take advantage of the benefits attributed to on-line games while teaching English to native Korean speakers. We expected to see that the improvements in the subjects’ English language abilities after playing the HoDoo English game would be associated with increased brain functional connectivity in the areas of the brain involved in the language production (Broca’s area) and the understanding (Wernicke’s area) networks. Twelve children, aged nine and ten, were asked to play the on-line English education game for 50 minutes per day, five days per week for twelve weeks. At baseline, and again at the end of twelve weeks of game play, each child’s English language ability was assessed and a functional magnetic resonance imaging (fMRI) scan was conducted. The on-line English education game play effectively improved English language skills, especially in terms of non-verbal pragmatic skills. Following twelve weeks of on-line English education game play, the children showed positive connectivity between Broca’s area and the left frontal cortex as well as between Wernicke’s area and the left parahippocampal gyrus and the right medial frontal gyrus. Changes in pragmatic scores were positively correlated with average peak brain activity in the left parahippocampal gyrus. To the best of our knowledge, this is the first study to report an improvement in English ability and changes in brain activity within language areas after on-line language education game play.

Background: Dysphagia is a common symptom and an important prognostic factor in Parkinson’s disease (PD). Although cognitive and motor dysfunctions may contribute to dysphagia in patients with PD, any specific association between such problems and swallowing functions is unclear. Here, we examined the potential relationship between cognitive/motor components and swallowing functions in PD. We evaluated the contributions of cognition and motor function to the components of swallowing via video fluoroscopic swallowing (VFS) experiments. Methods: We prospectively enrolled 56 patients without dementia having PD. Parkinson’s disease severity was assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS). All participants received neuropsychological tests covering general mental status, visuospatial function, attention, language, learning and memory, and frontal executive function. The well-validated “modified barium swallow impairment profile” scoring system was applied during VFS studies to quantify swallowing impairments. Finally, correlations between neuropsychological or motor functions and impairment in swallowing components were calculated. Results: The most significant correlations were found between the frontal/executive or learning/memory domains and the oral phase of swallowing, though a minor component of the pharyngeal phase correlated with frontal function as well. Bradykinesia and the UPDRS total score were associated with both the pharyngeal and oral phases. Conclusions: Our findings suggest that cognitive dysfunctions are associated with the oral phase of swallowing in patients with early stage PD while the severity of motor symptoms may be associated with overall swallowing function.

Liquorice is one of the botanicals used frequently as a traditional medicine in the West and in the East. Platelet-derived growth factor (PDGF)-BB is involved in the development of CVD by inducing abnormal proliferation and migration of vascular smooth muscle cells. In our preliminary study, dehydroglyasperin C (DGC), an active compound of liquorice, showed strong antioxidant activity. Since phytochemicals with antioxidant activities showed beneficial effects on chronic inflammatory diseases, the present study aimed to investigate the effects of DGC on PDGF-induced proliferation and migration of human aortic smooth muscle cells (HASMC). Treatment of HASMC with DGC for 24 h significantly decreased PDGF-induced cell number and DNA synthesis in a dose-dependent manner without any cytotoxicity, as demonstrated by the 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyltetrazolium bromide test and thymidine incorporation. Upon cell cycle analysis, DGC blocked the PDGF-induced progression through the G0/G1 to S phase of the cell cycle, and down-regulated the expression of cyclin-dependent kinase (CDK); 2, cyclin E, CDK4 and cyclin D1. Furthermore, DGC significantly attenuated PDGF-stimulated phosphorylation of PDGF receptor-β, phospholipase C-γ1, AKT and extracellular-regulated kinase 1/2, and DGC inhibited cell migration and the dissociation of actin filaments by PDGF. In a rat vascular balloon injury model, DGC suppressed an excessive reduction in luminal diameters and neointimal formation compared with the control group. These results demonstrate the mechanistic basis for the prevention of CVD and the potential therapeutic properties of DGC.

Glyceollins, one family of phytoalexins, are de novo synthesised from daidzein in the soyabean upon exposure to some types of fungus. The efficiency of glyceollin production appears to be influenced by soyabean variety, fungal species, and the degree of physical damage to the soyabean. The compounds have been shown to have strong antioxidant and anti-inflammatory activities, and to inhibit the proliferation and migration of human aortic smooth muscle cells, suggesting their potential to prevent atherosclerosis. It has also been reported that glyceollins have inhibited the growth of prostate and breast cancer cells in xenograft animal models, which is probably due to their anti-oestrogenic activity. In essence, glyceollins deserve further animal and clinical studies to confirm their health benefits.

Platelet-derived growth factor (PDGF)-BB can induce abnormal proliferation and migration of vascular smooth muscle cells (VSMC) that are involved in the development of CVD. In our preliminary study, phytoalexin glyceollins (glyceollins I, II and III) isolated from soyabean seeds cultured with Aspergillus sojae showed strong antioxidant and anti-inflammatory activity. Since antioxidants showed beneficial effects on chronic inflammatory diseases, the purpose of the present study was to examine the effects of glyceollins on PDGF-induced proliferation and migration in human aortic smooth muscle cells (HASMC). Incubation of resting HASMC with glyceollins for 24 h significantly diminished PDGF-increased cell number and DNA synthesis in a dose-dependent manner without any cytotoxicity. In addition to blocking of the PDGF-inducible progression through the G0/G1 to the S phase of the cell cycle, glyceollins down-regulated the expression of cyclin-dependent kinase (CDK)2 and cyclin D1, and up-regulated the expression of CDK inhibitors such as p27kip1 and p53.Glyceollins also effectively inhibited reactive oxygen species generation and phosphorylation of PDGF receptor-β, phospholipase Cγ1, Akt and extracellular signal-regulated kinase 1/2 by PDGF stimulation. Furthermore, glyceollins were found to inhibit PDGF-induced dissociation of actin filaments and cell migration. Thus, the results suggest that glyceollins could become a potent therapeutic agent for regulating VSMC-associated vascular disease such as atherosclerosis and restenosis after angioplasty.

Objectives: Recent concerns have been raised for the safety after drug-eluting stents (DES) implantation compared with the use of bare-metal stents (BMS) in patients with ST-elevation acute myocardial infarction (STEMI). The objective of this study was to estimate the relative impact of DES versus BMS on mortality, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis (ST) in STEMI patients by performing comprehensive meta-analyses of randomized controlled trials (RCTs) and observational studies.

Methods: We performed an electronic search and manual search of studies presented through September 2009, without language restrictions. An approach of “using systematic reviews” was used. Two independent reviewers extracted prespecified data from each study. A random-effects model was used to combine trials and to perform stratified analyses based on study designs and the duration of follow-up.

Results: Fourteen RCTs were identified (N = 7,654). Compared with BMS, DES significantly reduced TVR (risk ratio [RR], 0.48; 95 percent confidence interval [CI], 0.41–0.56) and MI (RR, 0.77; 95 percent CI, 0.61–0.97), without increasing mortality (RR, 0.88; 95 percent CI, 0.70–1.10) and ST (RR, 0.93; 95 percent CI, 0.72–1.21). Among 35 observational studies (N = 44,849), the use of DES was associated with a significant reduction in mortality (RR, 0.85; 95 percent CI, 0.79–0.91) and TVR (RR, 0.61; 95 percent CI, 0.48–0.77). MI and ST were significantly lower in the DES group within 1-year follow-up, but there were no differences within 2 years of follow-up. There was no evidence of statistical heterogeneity and publication bias.

Conclusions: These data in aggregate suggest that using DES in STEMI patients is safe and efficacious, but there are differences between RCT and observational data comparing DES and BMS.

Nitrogen-doped titania with a unique two-level hierarchical structure and visible light photocatalytic activity is reported. Thus, nitrogen-doped titanium oxide microrods decorated with N-doped titanium oxide nanosheets were synthesized by a hydrothermal reaction in NH4OH and postcalcination. During the calcination, the in situ incorporation of nitrogen atoms of ammonium ion into titania lattice was accompanied by the structural evolution from titanate to anatase titania. The morphological and structural evolution was monitored by scanning electron microscopy (SEM), x-ray diffraction (XRD), thermogravimetric analysis/differential thermal analysis (TGA/DTA), Raman, Fourier transform infrared (FTIR), x-ray absorption near edge structure (XANES), x-ray photoelectron spectroscopy (XPS), and adsorption isotherms. The N-doping brought visible light absorption, and the material exhibited high photocatalytic activity in the decomposition of Orange II under visible light irradiation (λ ≥ 400 nm), especially when it was loaded with 1 wt% Pt as a cocatalyst.

Decision making in an emotionally conflicting situation is important in social life. We aimed to address the similarity and disparity of neural correlates involved in processing ambivalent stimuli in patients with schizophrenia and patients with depression. Behavioral task-related hemodynamic responses were measured using [15O]H2O positron emission tomography (PET) in 12 patients with schizophrenia and 12 patients with depression. The task was a modified word-stem completion task, which was designed to evoke ambivalence in forced and non-forced choice conditions. The prefrontal cortex and the cerebellum were found to show increased activity in the healthy control group. In the schizophrenia group, activity in these two regions was negligible. In the depression group, the pattern of activity was altered and a functional compensatory recruitment of the inferior parietal regions was suggested. The prefrontal cortex seems to be associated with the cognitive control to resolve the conflict toward the ambivalent stimuli, whereas the cerebellum reflects the sustained working memory to search for compromise alternatives. The deficit of cerebellar activation in the schizophrenia group might underlie the inability to search and consider compromising responses for conflict resolution. (JINS, 2009, 15, 990–1001.)

This study investigated the associations among vitamin D receptor (VDR) BsmI polymorphism, calcium intake and bone strength as indicated by the broadband ultrasound attenuation (BUA) measured by calcaneal quantitative ultrasound at the left calcaneus in community-dwelling subjects with a low calcium intake. The VDR BsmI polymorphism was analysed in 335 women older than 65 years residing in rural Asan, Korea. Calcium intake was assessed with a 2 d, 24 h recall method. The distribution of genotypes was similar to that reported in other Asian populations (92 % bb, 7 % Bb and 1 % BB). The calcaneal BUA was significantly higher (P = 0·013) in the bb genotype than in the Bb or BB genotype (Bb and BB genotypes were combined due to the small number of BB subjects) in a multiple regression model after adjusting for age, body weight, height, physical activity and nutritional factors. BUA was not significantly affected by the calcium intake regardless of the genotype, cross-sectionally. The energy-adjusted average calcium intake of this population was 439·6 mg/d (432·5 mg/d for bb and 522·3 mg/d for Bb or BB), and 96 % of the subjects had dietary intakes that were less than the recommended Dietary Reference Intake for Koreans (which for calcium is 800 mg/d for women older than 65 years). In summary, the BUA in older Korean women with a low calcium intake was significantly influenced by the VDR genotype but not by the calcium intake, cross-sectionally.

We introduce a simple preparation method for ultrathin carbon support films that is especially useful for high-resolution electron microscopy (HREM) of nanoparticles. Oxidized iron nanoparticles were used as a test sample in a demonstration of this method. The film qualities are discussed on the basis of electron-energy-loss spectroscopy (EELS) and image analysis techniques such as thickness maps and histograms. We carried out a comparison between the homemade and commercial film qualities. The relative thickness of the homemade support films was 0.6 times less than that of the commercial films, which was calculated from the EELS analysis, whereas the thicknesses of both carbon support films varied within about 3%. The percentage of the observable area was about 67 ± 7.6% of the support film. This was about twice as large as the commercial film (32 ± 9.3%). The HREM image of the sample prepared with our support film improved 9% in brightness and 15% in contrast compared with images obtained with the commercial support.

Ag particles were generated on Ag+-doped polyimide film by ion exchanging, followed by copper deposition using metallic silver particles as seeds. The Cu layers were coated on the surface of polyimide films by electroless plating method. The surface image and morphology of Cu layers on the polyimide films were characterized with scanning electron microscopy (SEM), and atomic force microscopy (AFM). The chemical composition on the PI film was investigated energy dispersive X-ray (EDX) spectrometer.

Tin oxide has been proposed as a promising alternative anode material for microbatteries. It has been reported that its theoretical volumetric capacity is four times larger than that of carbon-based materials, while its gravimetric capacity is twice as large. In this experiment, optimal Si and Bi doped SnO2 films were prepared with e-beam evaporation to improve both the cycle performance and the reversible capacity. The films with addition of Si only exhibited reductions in aggregation of tin particles and formation of micro-cracks. However, there still remained cracks, which induce capacity loss during cycling. To improve capacity retention, Bi was added with Si to SnO2 films, which exhibited the highest reversible capacity of 200µAh/cm2-µm at 200th cycle. The films doped with Bi and Si were found to be ill-defined and featureless without noticeable particle aggregation and cracks. However, the films that underwent cycling tests showed again aggregated tin particles and formation of cracks, which would induce cell failure during cycling. We believe that some types of Li-Bi phases as mixed-conductor matrices have improved the cycle life.