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To investigate the impacts of depression screening, diagnosis and treatment on major adverse cardiac events (MACEs) in acute coronary syndrome (ACS).
Prospective cohort study including a nested 24-week randomised clinical trial for treating depression was performed with 5–12 years after the index ACS. A total of 1152 patients recently hospitalised with ACS were recruited from 2006 to 2012, and were divided by depression screening and diagnosis at baseline and 24-week treatment allocation into five groups: 651 screening negative (N), 55 screening positive but no depressive disorder (S), 149 depressive disorder randomised to escitalopram (E), 151 depressive disorder randomised to placebo (P) and 146 depressive disorder receiving medical treatment only (M).
Cumulative MACE incidences over a median 8.4-year follow-up period were 29.6% in N, 43.6% in S, 40.9% in E, 53.6% in P and 59.6% in M. Compared to N, screening positive was associated with higher incidence of MACE [adjusted hazards ratio 2.15 (95% confidence interval 1.63–2.83)]. No differences were found between screening positive with and without a formal depressive disorder diagnosis. Of those screening positive, E was associated with a lower incidence of MACE than P and M. M had the worst outcomes even compared to P, despite significantly milder depressive symptoms at baseline.
Routine depression screening in patients with recent ACS and subsequent appropriate treatment of depression could improve long-term cardiac outcomes.
This article examines the limitations of the gender mainstreaming discourse regarding the issue of childcare by women in South Korea, an area of responsibility that was transferred from the Ministry of Health and Welfare (MHW) to the Ministry of Gender Equality (MGE)1 in 2003. Through employing a discursive institutionalism approach, this article articulates that whilst the gender mainstreaming discourse has been interpreted at the surface level of politics, it has been formulated differently behind the scenes due to various policy interests. I argue that the discourse has remained at the level of superficial political rhetoric with underdeveloped understanding about the relationship between childcare and gender, thus retaining a stereotypical view of women as caregivers.
To determine the influence of early pain relief for patients with suspected appendicitis on the diagnostic performance of surgical residents.
A prospective randomized, double-blind, placebo-controlled trial was conducted for patients with suspected appendicitis. The patients were randomized to receive placebo (normal saline intravenous [IV]) infusions over 5 minutes or the study drug (morphine 5 mg IV). All of the clinical evaluations by surgical residents were performed 30 minutes after administration of the study drug or placebo. After obtaining the clinical probability of appendicitis, as determined by the surgical residents, abdominal computed tomography was performed. The primary objective was to compare the influence of IV morphine on the ability of surgical residents to diagnose appendicitis.
A total of 213 patients with suspected appendicitis were enrolled. Of these patients, 107 patients received morphine, and 106 patients received placebo saline. The negative appendectomy percentages in each group were similar (3.8% in the placebo group and 3.2% in the pain control group, p=0.62). The perforation rates in each group were also similar (18.9% in the placebo group and 14.3% in the pain control group, p=0.75). Receiver operating characteristic analysis revealed that the overall diagnostic accuracy in each group was similar (the area under the curve of the placebo group and the pain control group was 0.63 v. 0.61, respectively, p=0.81).
Early pain control in patients with suspected appendicitis does not affect the diagnostic performance of surgical residents.
Epidemiological studies have reported that higher education (HE) is associated with a reduced risk of incident Alzheimer's disease (AD). However, after the clinical onset of AD, patients with HE levels show more rapid cognitive decline than patients with lower education (LE) levels. Although education level and cognition have been linked, there have been few longitudinal studies investigating the relationship between education level and cortical decline in patients with AD. The aim of this study was to compare the topography of cortical atrophy longitudinally between AD patients with HE (HE-AD) and AD patients with LE (LE-AD).
We prospectively recruited 36 patients with early-stage AD and 14 normal controls. The patients were classified into two groups according to educational level, 23 HE-AD (>9 years) and 13 LE-AD (≤9 years).
As AD progressed over the 5-year longitudinal follow-ups, the HE-AD showed a significant group-by-time interaction in the right dorsolateral frontal and precuneus, and the left parahippocampal regions compared to the LE-AD.
Our study reveals that the preliminary longitudinal effect of HE accelerates cortical atrophy in AD patients over time, which underlines the importance of education level for predicting prognosis.
To compare the characteristics and risk factors for surgical site infections (SSIs) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a nationwide survey, using shared case detection and recording systems.
Retrospective cohort study.
Twenty-six hospitals participating in the Korean Nosocomial Infections Surveillance System (KONIS).
From 2006 to 2009, all patients undergoing THA and TKA in KONIS were enrolled.
SSI occurred in 161 (2.35%) of 6,848 cases (3,422 THAs and 3,426 TKAs). Pooled mean SSI rates were 1.69% and 2.82% for THA and TKA, respectively. Of the cases we examined, 42 (26%) were superficial-incisional SSIs and 119 (74%) were “severe” SSIs; of the latter, 24 (15%) were deep-incisional SSIs and 95 (59%) were organ/space SSIs. In multivariate analysis, a duration of preoperative hospital stay of greater than 3 days was a risk factor for total SSI after both THA and TKA. Diabetes mellitus, revision surgery, prolonged duration of surgery (above the 75th percentile), and the need for surgery due to trauma were independent risk factors for total and severe SSI after THA, while male sex and an operating room without artificial ventilation were independent risk factors for total and severe SSI after TKA. A large volume of surgeries (more than 10 procedures per month) protected against total and severe SSI, but only in patients who underwent TKA.
Risk factors for SSI after arthroplasty differ according to the site of the arthroplasty. Therefore, clinicians should take into account the site of arthroplasty in the analysis of SSI and the development of strategies for reducing SSI.
We present experimental evidence of enhancement of thermoelectric properties in tellurium (Te) nanoparticle-embedded bismuth antimony telluride (BiSbTe) alloys. Bi0.5Sb1.5Te3 films with a high density of Te particles of 10–20 nm size were prepared by growth of alternating multilayers of ultrathin Te and Bi0.5Sb1.5Te3. As the amount of Te nanoinclusions increased up to ∼15%, the Seebeck coefficient and thermoelectric power factor were increased. Based on the concept of band bending at heterointerfaces as a carrier energy filter, the energy relaxation calculation was made to confirm that the Te nanoinclusions result in a carrier energy filtering effect in p-type bismuth antimony telluride. In addition, thermal conductivities were reduced in the Te-embedded samples, permitting possible further enhancement of the thermoelectric figure of merit. The advantages of Te nanoinclusions in p-type Bi0.5Sb1.5Te3alloys on thermoelectric performance are experimentally realized by both electron- and phonon scattering.
Low temperature solid oxide fuel cells (SOFCs) are a promising solution to revolutionize stationary, transportation, and personal power energy conversion efficiency. Through investigation of fundamental conduction mechanisms, we have developed the highest conductivity solid electrolyte, stabilized bismuth oxide (Dy0.08W0.04Bi0.88O0.36). To overcome its inherent thermodynamic instability in the anode environment, we invented a functionally graded bismuth oxide/ceria bilayered electrolyte. For compatibility with this bilayared electrolyte, we developed high performance bismuth ruthenate–bismuth oxide composite cathodes. Finally, these components were integrated into an anode-supported cell with an anode functional layer, resulting in an exceptionally high power density of ∼2 W/cm2 at moderate temperatures (650 °C) and sufficient power down to 300–400 °C for most applications. Moreover, because SOFCs can operate on conventional fuels, these low temperature SOFCs provide one of the most efficient energy conversion technologies available without relying on a hydrogen infrastructure.
To evaluate the risk factors for surgical site infection (SSI) after gastric surgery in patients in Korea.
A nationwide prospective multicenter study.
Twenty university-affiliated hospitals in Korea.
The Korean Nosocomial Infections Surveillance System (KONIS), a Web-based system, was developed. Patients in 20 Korean hospitals from 2007 to 2009 were prospectively monitored for SSI for up to 30 days after gastric surgery. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using multivariate logistic regression models.
Of the 4,238 case patients monitored, 64.9% (2,752) were male, and mean age (±SD) was 58.8 (±12.3) years. The SSI rates were 2.92, 6.45, and 10.87 per 100 operations for the National Nosocomial Infections Surveillance system risk index categories of 0, 1, and 2 or 3, respectively. The majority (69.4%) of the SSIs observed were organ or space SSIs. The most frequently isolated microorganisms were Staphylococcus aureus and Klebsiella pneumoniae. Male sex (odds ratio [OR], 1.67 [95% confidence interval (CI), 1.09–2.58]), increased operation time (1.20 [1.07–1.34] per 1-hour increase), reoperation (7.27 [3.68–14.38]), combined multiple procedures (1.79 [1.13–2.83]), prophylactic administration of the first antibiotic dose after skin incision (3.00 [1.09–8.23]), and prolonged duration (≥7 days) of surgical antibiotic prophylaxis (SAP; 2.70 [1.26–5.64]) were independently associated with increased risk of SSI.
Male sex, inappropriate SAP, and operation-related variables are independent risk factors for SSI after gastric surgery.
We investigated the pressure dependence of the inductive coupled plasma (ICP) oxidation on the electrical characteristics of the thin oxide films. Activation energies and electron temperatures with different pressures were estimated. To demonstrate the pressure effect on the plasma oxide quality, simple N type metal-oxide-semiconductor (NMOS) transistors were fabricated and investigated in a few electrical properties. At higher pressure than 200mTorr, plasma oxide has a slightly higher on-current and a lower interfacial trap density. The on-current gain seems to be related to the field mobility increase and the lower defective interface to the electron temperature during oxidation.
Determining valid zygosity is a basic and important requirement in a twin study, because misdiagnosing zygosity leads to biased results. The Healthy Twin Study has collected data from adult like-sex twins and their families since 2005. In the study, a questionnaire to determine zygosity was developed comprising four questions; one concerning the degree of resemblance, and three concerning the degree of confusion by the resemblance. Among 2,761 individuals (624 twin pairs) of twin and their families, 406 pairs of twins (mean age 38.3, 63.5% women) with both questionnaire and genotype information were selected to examine the validity of the zygosity questionnaire using 16 short tandem repeat markers. We first determined individual zygosity including undetermined category, and then decided the zygosity of a twin pair using a decision tree. Sensitivity of questionnaire diagnosis was 98.8% for monozygotic (MZ) and 88.9% for dizygotic (DZ) twins, and positive predictive value was 97.2% for MZ and 95.0% for DZ. When we compared correctly and wrongly diagnosed twin pairs, misdiagnosed DZ twins (nine pairs) showed striking similarity in stature or obesity even exceeding that of true MZ twins. Our finding suggests that a parsimonious questionnaire method of diagnosing the zygosity will be useful, and adding physical or physiological measurements to a questionnaire of zygosity diagnosis will either confound the correct diagnosis or reduce the efficiency of the study compared with using questionnaire alone or with introducing genotyping.
To investigate the annual rate of tuberculosis (TB) infection among newly employed nurses using both tuberculin skin test (TST) and QuantiFERON-TB Gold (QFT-G; Cellestis Limited) assay.
A prospective cohort study involving newly employed nurses.
A tertiary care university hospital in South Korea.
All participants (n = 196) were tested with the TST and QFT-G assay at baseline. After 1 year, the TST and QFT-G assay were reperformed for subjects who had negative TST results at baseline and for all subjects, respectively.
The baseline TST and QFT-G assays were positive for 101 subjects (51.5%) and 28 subjects (14.3%), respectively; 22 subjects (11.2%) had positive results of both tests. Although the overall between-test agreement was 54.9% (κ = 0.151 [95% confidence interval, 0.047–0.245]), agreement improved to 78.5% (κ = 0.462 [95% confidence interval, 0.007–0.917]) for subjects who had not received bacille Calmette-Guérin vaccination. After 1 year, the TST yielded positive results for 16 (21.3%) of 75 nurses with negative baseline results, and the QFT-G assay yielded positive results for 21 (14.4%) of 146 subjects with negative baseline Results. Collectively, 5 subjects (3.0%) experienced conversion to positive results with both tests, and 32 subjects (18.9%) experienced conversion to positive results with one of the tests. Neither the employing hospital department nor exposure to patients with TB affected test conversion status.
The poor overall agreement between TST and QFT-G results may have been caused by the confounding effect of bacille Calmette-Guérin vaccination. The annual risk of TB infection among newly employed nurses was at least 3% on the basis of results of both the TST and QFT-G test. Stricter preventive strategies against TB spread should be implemented in our hospital.
Brain-derived neurotrophic factor (BDNF) signalling via tyrosine kinase B receptors may play an important role in ovarian development and function. It has been reported that metformin elevates the activity of Tyrosine kinase receptors and may amplify BDNF signalling. The objective of this study was to investigate the effect of BDNF during in vitro maturation (IVM) and/or in vitro culture (IVC) (Experiment 1), and to evaluate the collaborative effect of BDNF and metformin treatment on the developmental competence of bovine in vitro fertilized (IVF) embryos (Experiment 2). In Experiment 1, BDNF, which was added to our previously established IVM systems, significantly increased the proportions of MII oocytes at both 10 ng/ml (86.7%) and 100 ng/ml (85.4%) compared with the control (64.0%). However, there was no statistically significant difference in blastocyst development between the control or BDNF-supplemented groups. In Experiment 2, in order to investigate the effect of BDNF (10 ng/ml) and/or metformin (10−5 M) per se, TCM-199 without serum and hormones was used as the control IVM medium. The BDNF (48.3%) and BDNF plus metformin (56.5%) significantly enhanced the proportions of MII oocytes compared with the control (34.4%). Although, BDNF or metformin alone had no effect in embryo development, BDNF plus metformin significantly improved early embryo development to the 8–16-cell stage compared with the control (16.5 vs. 5.5%). In conclusion, the combination of BDNF and metformin may have a collaborative effect during the IVM period. These results could further contribute to the establishment of a more efficient bovine in vitro embryo production system.
We examined the effects of various exercise intensities on recovery from middle cerebral artery occlusion (MCAO) in rats.
First, we administered a 120-minute left MCAO to male Sprague-Dawley rats and randomly assigned them to one of four groups: no exercise (Group 1), mild exercise (Group 2), moderate exercise (Group 3), and severe exercise (Group 4). Then, we trained the rats for 30 min per day for one week or two weeks. We used a five-point neurological evaluation scale to measure neurological deficits 1-day, 4-days, 7-days, 10-days and 14-days after MCAO and measured infarct volume by use of 2% 2,3,4-triphenyltetrazolium chloride in exercised brains. We also performed immunohistochemistry analysis of the brain to observe reactive astrocytosis at the peri-infarct region.
Neurological examination indicated that Group 2 and 3 recovered better than Group 1 after one week and two weeks (p<0.05). Moreover, Group 2 and 3 had reduced brain infarct volume compared with Group 1 after one week (p<0.05). There were no significant differences between Group 4 and Group 1. The thickness of the peri-infarct astrocytosis was significantly reduced in Group 4 relative to Group 1 after one week. There was a significant negative correlation between the extent of reactive astrocytosis and neurological recovery (r= -0.648, p<0.01).
This study demonstrates that mild to moderate exercise that begins soon after induced cerebral ischemia promotes recovery and that astrocytes may have an important role in the recovery process.
To describe the incidence of recovery of both vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) from culture of a single clinical specimen, to describe the clinical characteristics of patients from whom these specimens were recovered, and to identify the risk factors of these patients.
A retrospective cohort and case-control study.
A tertiary care university hospital and referral center in Seoul, Korea.
We identified 61 case patients for whom a single clinical specimen yielded both VRE and MRSA on culture, and 122 control patients for whom any clinical specimen yielded only VRE on culture. The control patients were selected by matching 2 :1 with the case patients for age, sex, and first date of sampling that led to isolation of VRE or both VRE and MRSA among 1,536 VRE-colonized patients from January 1, 2003, through December 31, 2006. To identify patient risk factors for the recovery of both VRE and MRSA in a single clinical specimen, we performed univariate comparisons between the 2 groups and then multivariate logistic regression analysis.
The incidence of recovery of both VRE and MRSA from culture of a single clinical specimen was 3.97% (for 61 of 1,536 VRE-colonized patients) over 4 years. Among these 82 single clinical specimens, the most common type was wound specimens (26.8%), followed by lower respiratory tract specimens (18.3%), urine specimens (17.1%), and catheter tips (15.9%). Of the 61 case patients, 14 (23.0%) had 2 or more single clinical specimens that yielded both VRE and MRSA on culture, and the longest interval from the first sampling that yielded both organisms to the last sampling that yielded both was 174 days. Independent patient risk factors for the presence of both VRE and MRSA in a single clinical specimen were chronic renal disease (odds ratio [OR], 7.00; P = .012), urinary catheterization (OR, 3.36; P = .026), and longer total cumulative duration of hospital stay within the previous year (OR, 1.03; P < .001).
We confirmed that the recovery of VRE and MRSA from a single clinical specimen occurs continually. Because prolonged cell-to-cell contact can facilitate transfer of vanA, close observation and surveillance for vancomycin-resistant S. aureus, especially among patients with risk factors for the recovery of both VRE and MRSA from a single clinical specimen, should be continued.
Background: This study aims to establish the incidence rates of Alzheimer's disease (AD) and to understand the relations between illiteracy and AD in the Korean Yonchon survey cohort.
Methods: A community-based, dementia-free cohort of 966 people aged 65 years and older was followed up for an average of 5.4 ± 1.60 years to detect incident AD cases using a two-phase procedure. Age-specific incidence rates were calculated using a person-years approach with Poisson distribution confidence intervals. Data were analyzed using the Cox proportional hazards model to find the hazard ratio of illiteracy.
Results: The participating percentage of the survivors was 86.4% and 74 subjects were diagnosed with AD. Incidence rates per 1000 person-years were 20.99 (95% CI 16.48 to 26.35) for AD. The hazard ratio of illiteracy was 1.78 (95% CI 1.08 to 2.93) adjusted for age, sex, educational level. AD developed more rapidly with aging in the illiterate group than in the literate group.
Conclusions: Illiteracy is associated with a higher risk of AD and the risk increases with age.
This study compared the developmental competence of somatic cell nuclear transfer (SCNT) embryos reconstructed with different donor cells and analysed gene expression in the resulting embryos. Bovine fetal/adult ear fibroblasts and cumulus cells were used as donor cells and the developmental competence of the reconstructed embryos was monitored. The cell number and allocation in blastocysts were determined by differential staining. The Bax, E-cad, IF-tau, Hsp (heat shock protein) 70, Igf2r (insulin-like growth factor 2 receptor), DNMT (DNA methyltransferase) 1 and Mash (mammalian achaete-scute homologue) 2 genes were selected for gene expression analysis. The relative abundance (ratio to GAPDH mRNA) of gene transcripts in blastocysts was measured by semiquantitative reverse transcription-polymerase chain reaction. In experiment 1, development of SCNT preimplantation embryos and the cell numbers of inner cell masses and trophoblasts were not different among SCNT embryos derived from different cell types. In experiment 2, the relative expression of GAPDH and Hsp 70 transcripts was similar in all embryos. The expression of Bax, Igf2r and Mash2 transcripts was significantly increased in SCNT embryos reconstructed with adult fibroblasts. The E-cad transcript levels were reduced in SCNT embryos reconstructed with fetal fibroblasts. Relative abundance of DNMT1 in SCNT embryos derived from fetal fibroblasts was increased, and IF-tau expression in SCNT embryos derived from cumulus cells was increased. In conclusion, depending on the type of donor cells, preimplantation SCNT embryos displayed marked differences in gene expression. This may affect the developmental competence of SCNT embryos reconstructed with different cell types after implantation or during fetal growth in vivo.
We describe the design and implementation of RSTATION, an object-oriented, modular robot simulator with hierarchical analysis capabilities. Modularity is achieved via the features of design encapsulation and enables grouping a set of
interconnected components into a single component and dividing the robot system into several sets of subordinate modules recursively. By careful construction of the data types and classes, RSTATION allows for hierarchical simulation of the kinematics, and the dynamics at three levels: considering only main links (high-level), using simplified models including dynamic properties of transmission elements (intermediate level), and taking into account the detailed kinematics and dynamics of transmission elements (low-level). Submodules can be set to different resolution during a single simulation. The data types and classes also exploit a recent set of coordinate invariant robot analysis algorithms based on modern
screw theory. Central to the low-level dynamic analysis capability is an algorithm for systematically extracting the constraint equations for general gearing systems. The various features of RSTATION are illustrated with a detailed case study of a commercial industrial robot.