The hospital water environment serves as a reservoir for Gram-negative multidrug-resistant organisms. Drains, sinks, drink dispensers, toilets, and shower equipment were identified as sources of the outbreak. Plumbing systems with variable nutrient and microbial loads promote bacterial colonization and biofilm formation. Plumbing traps (P-traps) in sinks are the primary source of sink-related outbreaks. Pathogens are introduced into P-traps through handwashing and disposal of waste or nutrients. Some pathogens can survive and develop biofilms in P-traps. When nutrients are introduced, the biofilm can extend upwards, reaching the sink strainer. During faucet operation, aerosols and drain contents are dispersed into the surrounding environment. Guidelines for handwash basin design generally recommend that large basins contain splashes and taps that are not aligned directly over the drains to minimize aerosol generation. Ensuring that basins are not used for the disposal of patient-related waste or nutrients and prohibiting the storage of clean patient material near the sink is important. Daily cleaning and disinfection of sink surfaces with bleach (sodium hypochlorite) are essential. Additionally, self-disinfecting traps that use heat, vibration, or ultraviolet radiation have been reported to reduce microbial burden and prevent further biofilm formation. Eradicating sink and drain contamination is often difficult and outbreaks can recur. Even after the replacement of the sink, the sink component had only temporary effects, suggesting a persistent reservoir in the retained sink fit. Further research is needed to develop continuous and effective disinfection methods for sinks and drains.

The hospital water environment serves as a reservoir for Gram-negative multidrug-resistant organisms. Drains, sinks, drink dispensers, toilets, and shower equipment were identified as sources of the outbreak. Plumbing systems with variable nutrient and microbial loads promote bacterial colonization and biofilm formation. Plumbing traps (P-traps) in sinks are the primary source of sink-related outbreaks. Pathogens are introduced into P-traps through handwashing and disposal of waste or nutrients. Some pathogens can survive and develop biofilms in P-traps. When nutrients are introduced, the biofilm can extend upwards, reaching the sink strainer. During faucet operation, aerosols and drain contents are dispersed into the surrounding environment. Guidelines for handwash basin design generally recommend that large basins contain splashes and taps that are not aligned directly over the drains to minimize aerosol generation. Ensuring that basins are not used for the disposal of patient-related waste or nutrients and prohibiting the storage of clean patient material near the sink is important. Daily cleaning and disinfection of sink surfaces with bleach (sodium hypochlorite) are essential. Additionally, self-disinfecting traps that use heat, vibration, or ultraviolet radiation have been reported to reduce microbial burden and prevent further biofilm formation. Eradicating sink and drain contamination is often difficult and outbreaks can recur. Even after the replacement of the sink, the sink component had only temporary effects, suggesting a persistent reservoir in the retained sink fit. Further research is needed to develop continuous and effective disinfection methods for sinks and drains.

The hospital water environment serves as a reservoir for Gram-negative multidrug-resistant organisms. Drains, sinks, drink dispensers, toilets, and shower equipment were identified as sources of the outbreak. Plumbing systems with variable nutrient and microbial loads promote bacterial colonization and biofilm formation. Plumbing traps (P-traps) in sinks are the primary source of sink-related outbreaks. Pathogens are introduced into P-traps through handwashing and disposal of waste or nutrients. Some pathogens can survive and develop biofilms in P-traps. When nutrients are introduced, the biofilm can extend upwards, reaching the sink strainer. During faucet operation, aerosols and drain contents are dispersed into the surrounding environment. Guidelines for handwash basin design generally recommend that large basins contain splashes and taps that are not aligned directly over the drains to minimize aerosol generation. Ensuring that basins are not used for the disposal of patient-related waste or nutrients and prohibiting the storage of clean patient material near the sink is important. Daily cleaning and disinfection of sink surfaces with bleach (sodium hypochlorite) are essential. Additionally, self-disinfecting traps that use heat, vibration, or ultraviolet radiation have been reported to reduce microbial burden and prevent further biofilm formation. Eradicating sink and drain contamination is often difficult and outbreaks can recur. Even after the replacement of the sink, the sink component had only temporary effects, suggesting a persistent reservoir in the retained sink fit. Further research is needed to develop continuous and effective disinfection methods for sinks and drains.

The hospital water environment serves as a reservoir for Gram-negative multidrug-resistant organisms. Drains, sinks, drink dispensers, toilets, and shower equipment were identified as sources of the outbreak. Plumbing systems with variable nutrient and microbial loads promote bacterial colonization and biofilm formation. Plumbing traps (P-traps) in sinks are the primary source of sink-related outbreaks. Pathogens are introduced into P-traps through handwashing and disposal of waste or nutrients. Some pathogens can survive and develop biofilms in P-traps. When nutrients are introduced, the biofilm can extend upwards, reaching the sink strainer. During faucet operation, aerosols and drain contents are dispersed into the surrounding environment. Guidelines for handwash basin design generally recommend that large basins contain splashes and taps that are not aligned directly over the drains to minimize aerosol generation. Ensuring that basins are not used for the disposal of patient-related waste or nutrients and prohibiting the storage of clean patient material near the sink is important. Daily cleaning and disinfection of sink surfaces with bleach (sodium hypochlorite) are essential. Additionally, self-disinfecting traps that use heat, vibration, or ultraviolet radiation have been reported to reduce microbial burden and prevent further biofilm formation. Eradicating sink and drain contamination is often difficult and outbreaks can recur. Even after the replacement of the sink, the sink component had only temporary effects, suggesting a persistent reservoir in the retained sink fit. Further research is needed to develop continuous and effective disinfection methods for sinks and drains.

BACKGROUND: Anesthesia induction with desflurane is troublesome because of the frequent sympathetic hyperactivity during desflurane administration. We thought that a low concentration of desflurane combined with a target-controlled infusion (TCI) of remifentanil would eliminate the desflurane-related complications and provide hemodynamic stability during desflurane induction. An up-and-down study was planned to find the target effect-site concentration of remifentanil to block the hemodynamic response to endotracheal intubation, the highest level of stimulus, during anesthesia induction with administering desflurane at 1 MAC. METHODS: Remifentanil TCI was initiated before desflurane administration. When the preset target was achieved, spontaneous inhalation of desflurane 1 MAC was performed until the patients became unconscious. Laryngoscopic tracheal intubation was facilitated with rocuronium injection. The starting concentration of remifentanil and the test space were 5 and 1 ng/ml, respectively. The criteria for up-and-down was a 20% increase of the mean arterial pressure or heart rate after intubation. The median effective concentration (EC50) of remifentanil was calculated from 6 independent pairs. The complications related with remifentanil and desflurane were assessed during the study. RESULTS: We studied 20 patients using 2-5 ng/ml of the effect-site concentrations of remifentanil. The EC50 of remifentanil was 3.7 ng/ml. Loss of consciousness was achieved at 125 +/- 22 s after desflurane inhalation and this was irrespective of the combined remifentanil concentrations. Any remifentanil-related complication was not observed. Transient cough was seen in one patient who received 2 ng/ml of remifentanil. CONCLUSIONS: We demonstrated that uncomplicated induction with desflurane was possible by the use of target-controlled remifentanil. The EC50 of remifentanil to block the hemodynamic response to tracheal intubation was 3.7 ng/ml during inhalational induction with 1 MAC desflurane.
Androstanols ; Anesthesia ; Arterial Pressure ; Cough ; Heart Rate ; Hemodynamics ; Humans ; Inhalation ; Intubation ; Intubation, Intratracheal ; Isoflurane ; Isoxazoles ; Piperidines ; Unconscious (Psychology) ; Unconsciousness

Functional bladder disorders including overactive bladder and interstitial cystitis may induce problems in many other parts of our body such as brain and gut. In fact, diagnosis is often less accurate owing to their complex symptoms. To have correct diagnosis of these diseases, we need to understand the pathophysiology behind overlapped clinical presentation. First, we focused on reviewing literatures that have reported the link between bladder and brain, as the patients with bladder disorders frequently accompanied mood disorders such as depression and anxiety. Second, we reviewed literatures that have described the relationship between bladder and gut. There exist many evidences of patients who suffered from both bladder and intestinal diseases, such as irritable bowel syndrome and inflammatory bowel disease, at the same time. Furthermore, the interaction between brain and gut, well-known as brain-gut axis, might be a key factor that could change the activity of bladder and vice versa. For example, the affective disorders could alter the activity of efferent nerves or autonomic nervous system that modulate the gut itself and its microbiota, which might cause the destruction of homeostasis in bladder eventually. In this way, the communication between bladder and brain-gut axis might affect permeability, inflammation, as well as infectious etiology and dysbiosis in bladder diseases. In this review, we aimed to find an innovative insight of the pathophysiology in the functional bladder disorders, and we could provide a new understanding of the overlapped clinical presentation by elucidating the pathophysiology of functional bladder disorders.

Purpose: Several studies have been conducted on the relationship between green tea intake and metabolic syndrome. However, compared to the studies carried out internationally, there is inadequate research on the relationship between domestic green tea consumption and metabolic syndrome. Therefore, in this study, the general characteristics of Koreans according to their green tea intake and its association with metabolic syndrome were examined. Methods: A total of 44,611 subjects were included in the study, and analysis was carried out using data from the Korean Genome and Epidemiology Study (KoGES) for Korean adults aged 40 or older. Green tea consumption was estimated using 106 verified food frequency questionnaires (FFQ). Metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) parameters. After adjusting for confounding variables by performing a Cox regression analysis, the association between green tea consumption and metabolic syndrome was confirmed through the hazard ratio (HR) and 95% confidence interval (CI). Results: The average incidence of metabolic syndrome was 18.7% (20.8% in men and 17.8% in women). Compared to those who drank almost no green tea, in subject groups consuming more than one cup of green tea a day, the metabolic syndrome incidence was significantly reduced by 15% (HR, 0.85; 95% CI, 0.74–0.96; p trend = 0.0200) among men and by 19% (HR, 0.81; 95% CI, 0.73–0.90; p trend < 0.0001) among women. In addition, the biomarkers related to metabolic syndrome also tended to decrease overall in these groups. Conclusion This study concluded that as the intake of green tea increased, the incidence of metabolic syndrome and related indicators decreased. Therefore, green tea intake is believed to have a positive effect on the prevention and management of the metabolic syndrome.