Objective: Various patient placement criteria (PPC) have been developed to address alcohol use disorder (AUD), which has a high relapse rate and imposes substantial socioeconomic costs. Although research has shown PPC to be an effective tool, evidence supporting the Korean-PPC (K-PPC) is insufficient. This paper investigated whether treatment matching with the K-PPC was effective, based on variables related to AUD. Methods: In total, 524 participants were evaluated using the 6 dimensions of the K-PPC and levels of care (LoC) were recommended based on the results. Participants whose treatment matched with the recommended LoC were classified into the matched group, and those whose treatment did not match were classified into the mismatched group. Subsequently, treatment was planned according to the determined LoC, and a total of 3 follow-up evaluations were conducted at 1 month, 3 months, and 6 months. Results: There was no significant difference in the follow-up rate between the K-PPC matched group and the mismatched group. Of the variables measured by the 6 dimensions of the K-PPC, alcohol-related variables, depression, insight, and biomedical outcomes showed the most significant results (especially alcohol-related variables) from the baseline evaluation to the 6-month follow-up. In addition, the average adherence to the treatment program in the 6-month period was found to be higher in the matched group than in the mismatched group. Conclusion The K-PPC could be effective for placing patients and providing treatment by matching patient characteristics. Enhancing treatment program retention can also have a positive effect on clinical outcomes.

Purpose: This study aims to describe and identify in-depth the breastfeeding experience of primiparas for more than one year using a phenomenological research method and to raise the understanding of the primiparas’ subjective experiences during the breastfeeding process to contribute to the improving and maintaining maternal and child health. Methods: This research was a phenomenological and qualitative study conducted on 5 primiparas who continued breastfeeding for more than 12 months. Data was collected through individual in-depth interviews from November 1, 2021 to March 20, 2022, and it was analyzed through the sixth stage of phenomenological research analysis presented by Colaizzi. Results: The study consisted of 10 theme clusters and 26 themes from meaningful statements about the breastfeeding success experiences of primiparas for more than one year. The 10 theme collections were "Planning breastfeeding during pregnancy," "Commitment to breastfeeding through information and education," "Challenges faced during breastfeeding," "Continuous hard work," "Continued conflict over breastfeeding amid confusion," "Connects with experts who lead the way," "Establishes one's own standards and direction," "Peace after hard work," "Solid and firm confidence," and "Deep-rooted beliefs brestfeeding serve as reminders." Conclusion It is expected that this study will help to understand the individual difficulties and problems experienced by primiparas during breastfeeding, the importance of breastfeeding education, the role of medical personnel in the early stage of childbirth, social and environmental support, and the importance of an active window for information exchange. By identifying these factors, this study can serve as basic data for nursing practice to promote successful breastfeeding.

OBJECTIVES: The sensitivity and positive predictive value of widely used intraoperative neuromonitoring (IONM) using electromyography (EMG) of the vocalis muscle in thyroid surgery are controversial. Thus, we developed a novel IONM system with an accelerometer sensor that uses the piezoelectric effect instead of EMG to detect laryngeal twitching. The objective of this study was to evaluate the feasibility and safety of this novel IONM system during thyroid surgery in a porcine model. METHODS: We developed an accelerometer sensor that uses the piezoelectric effect to measure laryngeal twitching in three dimensions. This novel accelerometer sensor was placed in the anterior neck skin (transcutaneous) or postcricoid area. Stimulus thresholds, amplitude, and latency of laryngeal twitching measured using the accelerometer sensor were compared to those measured through EMG of the vocalis muscle. RESULTS: The amplitudes of the accelerometer sensor at the anterior neck and postcricoid area were significantly lower than those of EMG because of differences in the measurement method used to evaluate laryngeal movement. However, no significant differences in stimulus thresholds between the EMG endotracheal tube and transcutaneous or postcricoid accelerometer sensors were observed. CONCLUSION: Accelerometer sensors located at the anterior neck or postcricoid area were able to identify laryngeal twitching. The stimulus intensity measured with these sensors was equivalent to that from conventional vocalis EMG. Our novel IONM system with an accelerometer sensor that checks changes in surface acceleration can be an alternative to EMG of the vocalis muscle for IONM in the future.
Acceleration ; Electromyography ; Laryngeal Muscles ; Methods ; Neck ; Recurrent Laryngeal Nerve ; Skin ; Thyroid Gland ; Thyroidectomy

PURPOSE: To analyze the result of a repeat discectomy for ipsilateral recurrent lumbar disc herniation and to investigate the potential factors that influenced the outcomes for this surgery. MATERIALS AND METHODS: Fifty-nine patients, who underwent reoperation after lumbar discectomy with a minimum follow-up period of 2 years, were reviewed. The surgical outcome was assessed using the visual analogue scale (VAS) and Macnab classification, and the recovery rate was calculated in accordance with VAS. A statistical analysis was carried out by SPSS to evaluate the possible factors that may have influenced the outcomes of the reoperation. RESULTS: The rate of reoperation after lumbar disc surgery due to the recurrent disc herniation was 6.0% (59/983 cases). The average recovery rate of VAS from the 1st operation was approximately 77%, and from the 2nd operation was 71%. According to the Macnab criteria, the results were “excellent” or “good” in 96% of cases. Statistical analysis revealed that there was no difference of the average recovery rate (p<0.05). There is no additional instability after repeat discectomy. Factors, such as smoking, precipitating traumatic events, and diabetes mellitus did not have much influence on the average recovery rate after repeat discectomy for ipsilateral recurrent lumbar disc herniation. CONCLUSION: The outcomes of repeat discectomy were satisfactory. Moreover, factors, smoking, trauma history and diabetic mellitus, only had a minor impact on the outcomes of a repeat discectomy.
Classification ; Diabetes Mellitus ; Diskectomy* ; Follow-Up Studies ; Humans ; Reoperation ; Smoke ; Smoking

BACKGROUND: Melasma is a common acquired hyperpigmentation disorder that predominantly affects the face. It frequently occurs in women with darker skin types and severely impacts quality of life. OBJECTIVE: To characterize the clinicoepidemiological features and triggering or aggravating factors of melasma in Korean patients. METHODS: This cross-sectional study was conducted at the dermatology clinics of five university hospitals in Korea. Between January 2011 and August 2012, 411 patients with melasma completed a questionnaire about the clinical and aggravating factors associated with their melasma. RESULTS: The study population consisted of 400 women and 11 men aged 22~73 years (mean age, 42.8±9.92 years). Triggering or aggravating factors were sun exposure (68.4%), pregnancy (27.0%), and emotional stress (24.8%). Interestingly, 61.1% of patients complained of sensitive/inflammatory features such as erythema, itching, and a stinging sensation. Dryness was the most common aggravating factor, followed by erythema/redness and itching/stinging. Concomitant pigmentary disorders included post-inflammatory hyperpigmentation in 15.1% of patients, followed by pigmented contact dermatitis, and acquired bilateral nevus of Ota-like macules. CONCLUSION: It is well known that sun exposure and hormonal changes are the most common triggers of melasma; however, sensitive/inflammatory features may aggravate melasma in East Asian patients. Therefore, these individual and racial differences should be considered in the prevention and treatment of melasma.
Asian Continental Ancestry Group ; Bites and Stings ; Cross-Sectional Studies ; Dermatitis, Contact ; Dermatology ; Erythema ; Female ; Hospitals, University* ; Humans ; Hyperpigmentation ; Korea ; Male ; Melanosis* ; Nevus ; Pregnancy ; Pruritus ; Quality of Life ; Sensation ; Skin ; Solar System ; Stress, Psychological

BACKGROUND: The largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection outside Middle East Asia in 2015 has necessitated the rapid expansion of laboratories that conduct MERS-CoV molecular testing in Korea, together with external quality assessment (EQA) to evaluate the assays used. METHODS: The EQA program consisted of two phases; self-validation and blind assessment. For the first EQA phase, in vitro transcribed upstream region of the envelope gene (upE) and the open reading frame (ORF)1a RNAs were used at a concentration of 1,000 copies/microL. The test panel for the second EQA phase consisted of RNA extracts from three samples, which were obtained from two MERS-CoV positive patients and one MERS-CoV negative patient. RESULTS: The first EQA phase results for 46 participants showed a linear relationship between the threshold cycle (CT) values of RNA materials and the logarithmic concentrations for both upE and ORF1a gene targets (R2=0.73 and 0.75, respectively). The mean CT value for each concentration was different depending on which commercial kit was used for the assay. Among the three commonly used kits, PowerChek MERS Real-Time PCR kit (KogeneBiotech, Korea) showed the lowest CT values at all concentrations of upE and most concentrations of ORF1a. The second EQA phase results for 47 participants were 100% correct for all tested samples. CONCLUSIONS: This EQA survey demonstrates that the MERS-CoV molecular testing performed in Korea during the 2015 outbreak is of robust capability. However, careful establishment and validation of a cut-off value are recommended to ensure good analytical sensitivity.
Coronavirus Infections/*diagnosis/epidemiology/virology ; Disease Outbreaks ; Humans ; Middle East Respiratory Syndrome Coronavirus/*genetics/isolation & purification ; Molecular Diagnostic Techniques/*standards ; Quality Assurance, Health Care ; RNA, Viral/analysis ; Real-Time Polymerase Chain Reaction ; Republic of Korea/epidemiology ; Surveys and Questionnaires

Whether the metabolic syndrome (MetS) has prognostic value for coronary artery disease (CAD) beyond its individual components is controversial. We compared the relationship between the number of MetS components and CAD severity as assessed by angiography in non-diabetic and diabetic subjects. We consecutively enrolled 527 patients who underwent their first coronary angiography. Patients were divided into four groups according to the number of MetS components: 0/1, 2, 3, and 4/5. A coronary atherosclerosis score was used to quantify the extent of atherosclerotic involvement. The relationship between the MetS score and angiographic CAD severity or clinical presentation was compared between non-diabetic and diabetic subjects. Individuals with the MetS (n = 327) had a higher prevalence of CAD (60% vs 32%, P < 0.001), multi-vessel disease (34% vs 16%, P < 0.001), and acute coronary syndromes (49% vs 26%, P < 0.001) than those without the MetS. In the non-diabetic group, atherosclerosis score increased with the MetS score (1.0 +/- 2.1, 2.0 +/- 2.9, 2.8 +/- 2.9, and 3.6 +/- 3.9, P < 0.001) whereas there was no significant difference in the diabetic group (0.5 +/- 1.0, 5.2 +/- 4.7, 4.2 +/- 2.9, and 4.4 +/- 3.5, P = 0.102). The MetS score is related to CAD severity in non-diabetic patients but the association between the MetS score and angiographic CAD severity may be obscured in the presence of diabetes.
Adult ; Aged ; *Coronary Angiography ; Coronary Artery Disease/complications/*radiography ; Diabetes Mellitus, Type 2/*complications ; Female ; Humans ; Male ; Metabolic Syndrome X/*complications/diagnosis ; Middle Aged ; Odds Ratio ; Prognosis ; Republic of Korea ; Risk Factors ; *Severity of Illness Index

A hemodialysis room is the healthcare facility utmost demanding an infection control because dialysis patients have chronic serious underlying conditions and high risks of bloodborne infection due to a indwelling intravascular catheter, a frequent exposure to bloods or body fluids, and a blood transfusion as well as a hemodialysis room can be a mixing vessel to encounter both hospital-acquired pathogens and community-acquird pathogens. Therefore the Korean Society for Nosocomial Infection Control (KOSNIC) purposed to develop a guideline for the infection control in a hemodialysis room with support of Korean Center for Disease Control (KCDC). This guideline was composed of 11 chapters including vascular access control, dialysis water, microbiological and chemical monitoring of dialysis water and dialysates, components and passage of dialysates, maintenance of dialysis machines, disinfection, waste management, infection surveillance, aseptic techniques and standard precaution, environmental control, prevention of bloodborne infections and 5 appendices composing basic infection control techniques. This is the first official guideline approved by KOSNIC and KCDC of the infection control in a hemodialysis room in Korea. Here the guideline was published except appendices and entire guideline including those can be downloaded on hompages of KOSNIC (http://www.kosnic.org/) and KCDC (http//www.cdc.go.kr/).
Blood Transfusion ; Body Fluids ; Catheters ; Centers for Disease Control and Prevention (U.S.) ; Cross Infection ; Delivery of Health Care ; Dialysis ; Dialysis Solutions ; Disinfection ; Glycosaminoglycans ; Humans ; Infection Control ; Korea ; Renal Dialysis ; Waste Management ; Water

Two trials of external quality assessment for clinical microbiology laboratories were performed in 2009. A total of 16 specimens were distributed. Eight specimens were distributed to 339 laboratories with 322 (95.0%) returns in Trial I, and another eight specimens to 337 laboratories with 327 returns (97.0%) in Trial II. Two slide specimens for mycobacterium stain (AFB) were distributed in both Trial I and II. The acceptable percentages of Gram stain were relatively good for both stainability and morphology. The acceptable percentages of bacterial identification (correct answers to species level) on Sterotrophomonas maltophilia, Staphylococcus aureus, Streptococcus agalactiae, Micrococcus luteus, Vibrio parahemolyticus and Candida glabrata (Trial I) were 94.4%, 98.5%, 92.1%, 62.3%, 92.1% and 71.5%, respectively. The acceptable percentages of bacterial identification on Pseudomonas aeruginosa, Enterococcus faecalis, Candida albicans, Staphylococcus epidermidis, Moraxella catarrhalis and Enterobacter cloacae (Trial II) were 98.5%, 94.1%, 89.2%, 86.2%, 79.6% and 98.5%, respectively. The acceptable percentages for antimicrobial susceptibility tests on S. maltophilia and S. aureus (Trial I), and P. aeruginosa and E. faecalis(Trial II) were relatively good compared to data of the last year, except results using disk method for S. maltophilia. The acceptable percentages for AFB stain in Trial I and II were relatively high. In summary, the acceptable percentages of bacterial stain and identification were relatively good. However, it is still necessary that the quality assurance of the individual laboratories should be improved for antimicrobial susceptibility tests, and the selection of the most appropriate antimicrobial agents to test should be also considered.
Anti-Infective Agents ; Candida albicans ; Candida glabrata ; Enterobacter cloacae ; Enterococcus faecalis ; Korea ; Micrococcus luteus ; Moraxella (Branhamella) catarrhalis ; Mycobacterium ; Pseudomonas aeruginosa ; Staphylococcus aureus ; Staphylococcus epidermidis ; Streptococcus agalactiae ; Vibrio

BACKGROUND: Photodynamic therapy with using 5-aminolevulinic acid (ALA) is a good noninvasive treatment modality that can treat several cutaneous diseases. Yet hydrophilic ALA is not able to easily penetrate the cellular membrane or the lipid layer of the skin. Thus, various ALA alkyl esters been developed. OBJECTIVE: We studied whether novel ALA unsaturated alkyl esters synthesize more protoporhyrin IX (PpIX) than does ALA in mouse skin tissues. METHODS: We applied 5, 10, 15% ALA and ALA esters ointment to the skin of shaved mice, respectively. We harvested the skin tissue, made a preparation and did quantitative analysis according to the fluorescent spectrum for determining the amount of PpIX synthesized in the skin after the elapse of 1 hour and 3 hours, respectively. RESULTS: No matter what the sort or the concentration of the ALA and ALA ester was, the amount of synthesized PpIX increased more after the elapse of 3 hours than that after 1 hour. ALA (hetenyl-, petenyl-, butenyl-, methyl-) esters tended to produce a much greater amount of PpIX than ALA. According to the results of the comparative study with using 5%, 10% and 15% of ALA and ALA esters ointment, the amount of synthesized PpIX was not proportional to the concentration of the ALA and the ALA esters, even though the ALA esters produced more PpIX than the ALA. CONCLUSION: We found that the ALA unsaturated alkyl esters are a good photosensitizer and they are similar to ALA-me, which is an ALA saturated alkyl ester that induces more PpIX, an actual photosensitizer, than ALA can.
Aminolevulinic Acid ; Animals ; Esters ; Membranes ; Mice ; Photochemotherapy ; Protoporphyrins ; Skin