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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.
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.
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.
A unique nanowire growth was accomplished at 575 oC by the metal-induced growth (MIG). That is a spontaneous reaction between metal and Si. The deposited metal worked as a catalyst layer to grow nanowire in the solid-state. Various metals (Ni, Co, and Pd) were used in MIG nanowire fabrication and Ni-induced case was successful in demonstrating that metal species should be a dominant mover in nanowire growth. Transmission electron microscopy investigation was performed to observe the nanowire growth direction. 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 MIG nanowire was proven by fabricating nanoscale contacts.
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