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Background: The purpose of this study was to find out the relationship between appropriateness of antibiotic prescription and clinical outcomes in patients with community-acquired acute pyelonephritis (CA-APN). Methods: A multicenter prospective cohort study was performed in 8 Korean hospitals from September 2017 to August 2018. All hospitalized patients aged ≥19 years diagnosed with CA-APN at admission were recruited. Pregnant women and patients with insufficient data were excluded. In addition, patients with prolonged hospitalization due to medical problems that were not associated with APN treatment were excluded. The appropriateness of empirical and definitive antibiotics was divided into “optimal,” “suboptimal,” and “inappropriate,” and optimal and suboptimal were regarded as appropriate antibiotic use. The standard for the classification of empirical antibiotics was defined reflecting the Korean national guideline for the antibiotic use in urinary tract infection 2018. The standards for the classification of definitive antibiotics were defined according to the result of in vitro susceptibility tests of causative organisms. Clinical outcomes including clinical failure (mortality or recurrence) rate, hospitalization days, and medical costs were compared between patients who were prescribed antibiotics appropriately and those who were prescribed them inappropriately. Results: In total, 397 and 318 patients were eligible for the analysis of the appropriateness of empirical and definitive antibiotics, respectively. Of these, 10 (2.5%) and 18 (5.7%) were inappropriately prescribed empirical and definitive antibiotics, respectively, and 28 (8.8%) were prescribed either empirical or definitive antibiotics inappropriately. Patients who were prescribed empirical antibiotics appropriately showed a lower mortality rate (0 vs 10%; P = .025), shorter hospitalization days (9 vs 12.5 days; P = .014), and lower medical costs (US$2,333 vs US$4,531; P = .007) compared to those who were prescribed empirical antibiotics “inappropriately.” In comparison, we detected no significant differences in clinical outcomes between patients who were prescribed definitive antibiotics appropriately and those who were prescribed definitive antibiotics inappropriately. Patients who were prescribed both empirical and definitive antibiotics appropriately showed a lower clinical failure rate (0.3 vs 7.1%; P = .021) and shorter hospitalization days (9 vs 10.5 days; P = .041) compared to those who were prescribed either empirical or definitive antibiotics inappropriately. Conclusions: Appropriate use of antibiotics leads patients with CA-APN to better clinical outcomes including fewer hospitalization days and lower medical costs.
Early replacement of a new central venous catheter (CVC) may pose a risk of persistent or recurrent infection in patients with a catheter-related bloodstream infection (CRBSI). We evaluated the clinical impact of early CVC reinsertion after catheter removal in patients with CRBSIs.
We conducted a retrospective chart review of adult patients with confirmed CRBSIs in 2 tertiary-care hospitals over a 7-year period.
To treat their infections, 316 patients with CRBSIs underwent CVC removal. Among them, 130 (41.1%) underwent early CVC reinsertion (≤3 days after CVC removal), 39 (12.4%) underwent delayed reinsertion (>3 days), and 147 (46.5%) did not undergo CVC reinsertion. There were no differences in baseline characteristics among the 3 groups, except for nontunneled CVC, presence of septic shock, and reason for CVC reinsertion. The rate of persistent CRBSI in the early CVC reinsertion group (22.3%) was higher than that in the no CVC reinsertion group (7.5%; P = .002) but was similar to that in the delayed CVC reinsertion group (17.9%; P > .99). The other clinical outcomes did not differ among the 3 groups, including rates of 30-day mortality, complicated infection, and recurrence. After controlling for several confounding factors, early CVC reinsertion was not significantly associated with persistent CRBSI (OR, 1.59; P = .35) or 30-day mortality compared with delayed CVC reinsertion (OR, 0.81; P = .68).
Early CVC reinsertion in the setting of CRBSI may be safe. Replacement of a new CVC should not be delayed in patients who still require a CVC for ongoing management.
To examine the hypothesis that the association between vitamin D deficiency and depressive symptoms is dependent upon total cholesterol level in a representative national sample of the South Korean population.
This was a population-based cross-sectional study.
The Fifth Korean National Health and Nutrition Examination Survey (KNHANES V, 2010–2012).
We included 7198 adults aged 20–88 years.
The incidence of depressive symptoms in individuals with vitamin D deficiency (serum 25-hydroxyvitamin D<20 ng/ml) was 1·54-fold (95 % CI 1·20, 1·98) greater than in individuals without vitamin D deficiency (serum 25-hydroxyvitamin D ≥20 ng/ml). The relationship was stronger in individuals with normal-to-borderline serum total cholesterol (serum total cholesterol<240 mg/dl; OR=1·60; 95 % CI 1·23, 2·08) and non-significant in individuals with high serum total cholesterol (OR=0·97; 95 % CI 0·52, 1·81) after adjustment for confounding variables (age, sex, BMI, alcohol consumption, smoking status, regular exercise, income level, education level, marital status, changes in body weight, perceived body shape, season of examination date and cholesterol profiles).
The association between vitamin D deficiency and depressive symptoms was weakened by high serum total cholesterol status. These findings suggest that both vitamin D and total cholesterol are important targets for the prevention and treatment of depression.
The aim of this study is to examine a relationship between a change in social activity and depression among Koreans aged 45 years or more.
Data came from the Korean Longitudinal Study of Aging (KLoSA) (2006–2010), with 5,327 participants aged 45 years or more. The generalized estimating equation (GEE) with the logit link was used to investigate an association between a change in social activity during 2006–2008 (or 2008–2010) and depression among respondents in year 2008 (or Y2010). Depression was measured by Center for Epidemiological Studies Depression scale (CES-D10) and a change in social activity was classified with four categories, i.e. “consistent participation”, “consistent non-participation”, “participation to non-participation”, and “non-participation to participation”. Social activity was divided into various elements and the same analysis was conducted for each of these elements.
Those with consistent non-participation and from participation to non-participation were more likely to be depressed than those with consistent participation and from non-participation to participation in social activities (OR 1.44 [95% CI 1.22–1.71], OR 1.35 [95% CI 1.15–1.58] vs. OR 1.00 [Reference], OR 1.27 [95% CI 1.09–1.48]). In addition, the strength of the negative association between consistent or new participation in social activity and depression was different across different elements of social activity. The negative association was particularly strong for leisure, culture or sports clubs, and for family or school reunion.
For improving the mental health of the population aged 45 years or more, the promotion of their continued or new participations in leisure/culture clubs and family/school reunion might be needed in South Korea.
This study aimed to investigate the influences of age, education, and gender on the two total scores (TS-I and TS-II) of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological assessment battery (CERAD-NP) and to provide normative information based on an analysis for a large number of elderly persons with a wide range of educational levels.
In the study, 1,987 community-dwelling healthy volunteers (620 males and 1,367 females; 50–90 years of age; and zero to 25 years of education) were included. People with serious neurological, medical, and psychiatric disorders (including dementia) were excluded. All participants underwent the CERAD-NP assessment. TS-I was generated by summing raw scores from the CERAD-NP subtests, excluding Mini-Mental State Examination and Constructional Praxis (CP) recall subtests. TS-II was calculated by adding CP recall score to TS-I.
Both TS-I and TS-II were significantly influenced by demographic variables. Education accounted for the greatest proportion of score variance. Interaction effect between age and gender was found. Based on the results obtained, normative data of the CERAD-NP total scores were stratified by age (six overlapping tables), education (four strata), and gender.
The normative information will be very useful for better interpretation of the CERAD-NP total scores in various clinical and research settings and for comparing individuals’ performance of the battery across countries.
The charging effects of microfibrils of sciatic nerve tissues due to electron irradiation are investigated using electron holography. The phenomenon that the charging effects are enhanced with an increase of electron intensity is visualized through direct observations of the electric potential distribution around the specimen. The electric potential at the surface of the specimen could be quantitatively evaluated by simulation, which takes into account the reference wave modulation due to the long-range electric field.
The detailed knowledge of the three-dimensional (3D) organization of the nervous tissue provides essential information on its functional elucidation. We used serial block-face scanning electron microscopy with focused ion beam (FIB) milling to reveal 3D morphologies of the mossy fiber rosettes in the mice cerebellum. Three-week-old C57 black mice were perfused with a fixative of 1% paraformaldehyde/1% glutaraldehyde in phosphate buffer; the cerebellum was osmicated and embedded in the Araldite. The block containing granule cell layer was sliced with FIB and observed by field-emission scanning electron microscopy. The contrast of backscattered electron image of the block-face was similar to that of transmission electron microscopy and processed using 3D visualization software for further analysis. The mossy fiber rosettes on each image were segmented and rendered to visualize the 3D model. The complete 3D characters of the mossy fiber rosette could be browsed on the A-Works, in-house software, and some preliminary quantitative data on synapse of the rosette could be extracted from these models. Thanks to the development of two-beam imaging and optimized software, we could get 3D information on cerebellar mossy fiber rosettes with ease and speedily, which would be an additive choice to explore 3D structures of the nervous systems and their networks.
Leaf stomatal characteristics of Siberian elm (Ulmus pumila) were investigated by electron microscopy and white light scanning interferometry. On the basis of average annual precipitations, two types of tree specimens were collected from Korea, China, and Mongolia: (1) trees under normal environmental conditions and (2) trees under arid conditions. Field emission scanning electron microscopy revealed oval-shaped stomata on the lower surface, and they were ca. 20 μm in width. In-lens secondary electron imaging showed differences in electron density and stomatal pore depth between the two types. According to the line profile analysis by white light scanning interferometry, stomata under arid conditions appeared to have higher levels of the stomatal pore depth than ones under normal conditions. Focused ion beam–field emission electron microscopy supported the increased stomatal pore depth with the increasing drought stress gradient. These results suggest that complementary microscopy can be employed to unravel the adaptive phenotypic plasticity of Siberian elm in response to drought stress.
In 2011 the Black-faced Spoonbill Platalea minor census recorded a 22% drop in numbers from 2010, particularly at the known large coastal wintering sites. During this period, we discovered two new inland wintering sites for the species using satellite telemetry data, one located in China, where the individual followed the Yangtze river as far as Wuhan (500 km inland), and the other across the Vietnam-Cambodia border (70–200 km inland). Long periods of concentrated use of various freshwater habitats were in evidence for these two tagged individuals (China: 79 days, Vietnam/Cambodia: 91 Days) and in the latter case visual confirmation indicated a larger group of at least five individuals. The importance and potential of inland freshwater environments is highlighted towards the further conservation of the recovering population.
Background: Mortality associated with depression may be influenced by severity of depression and gender. We investigated the differential impacts on all-cause mortality of late-life depression by the type of depression (major depressive disorder, MDD; minor depressive disorder, MnDD; subsyndromal depression, SSD) and gender after adjusting comorbid conditions in the randomly sampled elderly.
Methods: One thousand community-dwelling elderly individuals were enrolled. Standardized face-to-face clinical interviews, neurological examination, and physical examination were conducted to diagnose depressive disorders and comorbid cognitive disorders. Depressive disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria and SSD to study-specific operational criteria. Five-year survivals were compared between groups using Cox proportional hazards models.
Results: By the end of 2010, 174 subjects (17.4%) died. Depressive disorder (p = 0.001) and its interaction term with gender (p < 0.001) were significant in predicting five-year survival. MDD was an independent risk factor for mortality in men (hazard ratio = 3.65, 95% confidence interval = 1.67–7.96) whereas MnDD and SSD were not when other risk factors were adjusted.
Conclusions: MDD may directly confer the risk of mortality in elderly men whereas non-major depression may be just an indicator of increased mortality in both genders.
Mg deficiency increases the concentration of Zn in the liver. We investigated the effect of Mg deficiency on the expression of Zn-regulating factors such as Zn transporters and metallothionein (MT) in the rat liver. Because Ca deficiency alleviates some of the effects of Mg deficiency, we also investigated the interactions associated with Ca and Mg deficiencies. Growing male rats were given a control diet, a Mg-deficient diet, a Ca-deficient diet and a Mg- and Ca-deficient diet for 3 weeks. Mg and Ca deficiencies additively increased the mRNA levels of MT-1 and MT-2, the MT protein concentration and the concentration of Zn in the liver. The hepatic mRNA level of Zip14 increased with Mg deficiency but not with Ca deficiency. The dietary treatments did not affect the mRNA levels of other Zn transporters such as Zip1, Zip5, ZnT1, ZnT5 and ZnT6 in the liver. Ca deficiency was found to decrease the amount of femoral Zn and increase serum Zn concentration. This did not occur in the case of Mg deficiency. These results suggest that Mg deficiency enhances hepatic Zn uptake by the up-regulation of Zip14 expression and increases hepatic Zn concentration, leading to the enhancement of MT expression. Ca deficiency causes a transfer of Zn from the bone to the liver, which increases hepatic Zn concentration and, in turn, up-regulates the expression of MT. Because Mg and Ca deficiencies increase hepatic Zn concentration and increase MT expression by different mechanisms, their effects are additive.
Morphology of foliar trichomes was analyzed in Quercus variabilis by electron microscopy and three-dimensional surface profiling. Leaves from suppressed or dominant sprouts of the oak species were collected after a forest fire to unravel the effects of the disturbance factor on sprouting of the oak species. Scanning electron microscopy revealed two types of trichomes depending on the leaf surface. The trichomes on the adaxial surface were branched and constricted, and possessed a single row of thin-walled cells with a collapsed morphology (glandular branched uniseriate trichomes). Meanwhile, the trichomes on the abaxial surface were star-shaped, unfused with each other, and had 6 to 10 rays (nonglandular simple stellate trichomes). An apparent proliferation of trichomes was evident on the adaxial surface of the dominant sprouts. Uniseriate trichomes could be discernable as an elevation from the surface by white light scanning interferometry. By transmission electron microscopy, thin and convoluted cell wall, degenerated cytoplasm, and a single row of cells were characteristic of the trichomes on the adaxial surface. The thick cell walls of the mature trichomes on the abaxial surface represented the nonglandular nature. This is the first report on the morphological and ultrastructural characterization of foliar trichomes of the oak species.
In this paper, we propose rapid-control prototyping (RCP) for a robot soccer using the SIMTool that has been developed in Seoul National University, Korea, for the control-aided control system design (CACSD). The proposed RCP enables us to carry out the rapid design and the verification of controls for two-wheeled mobile robots (TWMRs), players in the robot soccer, without writing C codes directly and requiring a special H/W. On the basis of the proposed RCP, a blockset for the robot soccer is developed for easy design of a variety of mathematical and logical algorithms. All blocks in the blockset are made up of basic blocks offered by the SIMTool. Applied algorithms for specific purposes can be easily and efficiently constructed with just a combination of the blocks in the blockset. As one of the algorithms implemented with the developed blockset, a novel navigation algorithm, called a reactive navigation algorithm using the direction and the avoidance vectors based scheme (RNDAVS), is proposed. It is shown through simulations and experiments that the RNDAVS designed with the proposed RCP can avoid a local minima and the goal non-reachable with obstacles nearby (GNRON) arising from the existing methods. Furthermore, in order to validate the proposed RCP in a real game, we employ an official simulation game for the robot soccer, the SimuroSot. Block diagrams are constructed for strategy, path calculation, and the interface to the SIMTool. We show that the algorithms implemented with the proposed RCP work well in the simulation game.
Large-volume cadmium zinc telluride (CZT) radiation detectors would greatly improve radiation detection capabilities and, therefore, attract extensive scientific and commercial interests. CZT crystals with volumes as large as hundreds of centimeters can be achieved today due to improvements in the crystal growth technology. However, the poor performance of large-volume CZT detectors is still a challenging problem affecting the commercialization of CZT detectors and imaging arrays. We have employed Pockels effect measurements and synchrotron X-ray mapping techniques to investigate the performance-limiting factors for large-volume CZT detectors. Experimental results with the above characterization methods reveal the non-uniform distribution of internal electric field of large-volume CZT detectors, which help us to better understand the responsible mechanism for the insufficient carrier collection in large-volume CZT detectors.
Density functional theory was used to investigate the adsorption and reaction of HfCl4 with two hydroxyls on Si (001)-2×1 surface in atomic layer deposition (ALD) process. When H2O molecules are adsorbed on Si (001) surface at room temperature, they are dissociated with hydrogens and hydroxyls. There are two dissociation pathways; inter-dimer dissociation and intra-dimer dissociation. The activation energies of these pathways can be converted to the reaction probabilities. It was approximately 2:1. We prepared a reasonable Si substrate which consisted of six inter-dimer dissociated H2O molecules and two intra-dimer dissociated H2O molecules. The HfCl4 must react with two hydroxyls to be a bulk-like structure. There were five reaction pathways where HfCl4 could react with two hydroxyls; inter-dimer, intra-dimer, cross-dimer, inter-row, and cross-row. Inter-row, inter-dimer and intra-dimer were relatively stable among the five reaction pathways based on the energy difference. The electron densities between O and Hf in these three reactions were higher than the others and they had shorter Hf-O and O-O bond lengths than the other two reaction pathways.
The sap of Acer mono has been called ‘bone-benefit-water’ in Korea because of its mineral and sugar content. In particular, the calcium concentration of the sap of A. mono is 37·5 times higher than commercial spring water. In the current study, we examined whether A. mono sap could improve or prevent osteoporosis-like symptoms in a mouse model. Male mice (3 weeks old) were fed a low-calcium diet supplemented with 25, 50 or 100 % A. mono sap, commercial spring water or a high calcium-containing solution as a beverage for 7 weeks. There were no differences in weekly weight gain and food intake among all the groups. Mice that were given a low-calcium diet supplemented with commercial spring water developed osteoporosis-like symptoms. To assess the effect of sap on osteoporosis-like symptoms, we examined serum calcium concentration, and femur density and length, and carried out a histological examination. Serum calcium levels were significantly lower in mice that received a low-calcium diet supplemented with commercial spring water (the negative control group), and in the 25 % sap group compared to mice fed a normal diet, but were normal in the 50 and 100 % sap and high-calcium solution groups. Femur density and length were significantly reduced in the negative control and 25 % sap groups. These results indicate that a 50 % sap solution can mitigate osteoporosis-like symptoms induced by a low-calcium diet. We also examined the regulation of expression of calcium-processing genes in the duodenum and kidney. Duodenal TRPV6 and renal calbindin-D9k were up-regulated dose-dependently by sap, and the levels of these factors were higher than those attained in the spring water-treated control. The results demonstrate that the sap of A. mono ameliorates the low bone density induced by a low-calcium diet, most likely by increasing calcium ion absorption.
Unique nanowire growth was accomplished at 575 °C by the metal-induced growth (MIG) method. This involved a spontaneous reaction between metal and Si. The deposited metal worked as a catalyst layer to grow nanowires in the solid state. Various metals (Ni, Co, and Pd) were used in MIG nanowire fabrication, and the Ni-induced case was successful in demonstrating that metal species should be the dominant factor for growing nanowires. The Ni to Si composition was studied by energy dispersive spectroscopy showing the Ni diffusion inside the nanowire as well as the Ni silicide layer. The practical application of the MIG nanowire was proved by fabricating nanoscale contacts.
We report on the basic characteristics and gas sensing operation of density controlled single-walled carbon nanotube (SWCNT) thin films on poly(dimethyl siloxane) (PDMS) substrates The vacuum filteration and PDMS mold transfer method allowed the density of SWCNT distributed to have non-local uniformity. The optical transparency of the SWCNT thin films was inversely proportional to SWCNT density and conductivity. The flexible SWCNT thin film showed high mechanical stability with negligible change in conductance after being bent by 180o. We evaluated its gas sensing operation depending on SWCNT density and bias voltage. It was shown that lower SWCNT density thin films had higher sensitivity to NH3 gas, which may be due to higher exposed surface area for lower density SWCNT thin films. Also, we found that lower bias voltage devices showed faster recovery times. The results show that vacuum filteration and mold transfer method produced flexible SWCNT thin films that have stable mechanical and electrical characteristics and also stable gas sensing capabilities making them applicable to future flexible integrated sensors.