Long segmental fixation with TSRH posterior instrumentation for 19 patients who had unstable thoracolumbar fracture was performed between October 1992 and April 1995. The patients were followed for an average of 22 months. Measurements of the deformity angle, kyphosis, vertebral height, and the intervertebral angle were made. The patients were divided into 2 groups according to configurations of instruments for lower segmental fixation. For one group, only hooks were used, and for the others group pedicular screws and lateral offset hooks were used together at the same segment. Therefore, the purpose of this study is to anlyze the correctability following long segmental fixation and to compare one segmental fixation using both screws and lateral offset hook systems with two segmental fixation using hook systems for distal fixation. There was an overall correction of kyphosis at follow-up of 6.9degrees (27.1%) after a loss of 4.3degrees from operative correction. Overall correction of deformity angle was 8.2degrees (32.2%). Loss of vertebral height at final follow-up was 4.4%. And loss of intervertebral angle was 2.0degrees at follow-up. There was no difference of overall results between the hook group and the pedicular screw with lateral offset hook group. However, there was a significant improvement of the correction of kyphosis and restoration of vertebral height in patients who underwent operation within 7 days after injury, as compared to delayed operation. Therefore, the timing of surgery is the most important factor in order to correct the deformity caused by unstable thoracolumbar fractures. There was no significant loss of correction and no metallic failure. Therefore, rodding long with the method of one segment distal fixation using screws and lateral offset hook together can provide excellent correctability, maintenance of correction, preservation of distal lumbar joints, prevention of implant failure and complication.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Joints ; Kyphosis

Vibrio vulnificus is an estuarine bacterium that opportunistically infects humans with underlying hepatic diseases, heavy alcohol drinking habits, and other immunocompromised conditions. A locus in the V. vulnificus genome was cloned and sequenced, which showed similarities to the bacterial two-component signal transduction system. The locus encoded a putative sensor kinase, designated vvgS, and a divergently transcribed putative response regulator, designated vvgR. VvgS was predicted to be a protein belonging to the tripartite hybrid sensor kinase subfamily such as ArcB and BvgS. VvgR showed similarities to well known response regulators. An insertional mutation of vvgS in a V. vulnificus strain led to a remarkable decrease of cytotoxicity to HeLa cells, while the production of exotoxins, the hemolysin and the protease, slightly increased by the vvgS mutation. Adhesion to HeLa cells only slightly decreased. However, the vvgS mutation had no effect on the motility of V. vulnificus. The vvgS mutation resulted in a significant decrease of lethality to mice. These results indicate that vvgRS two-component system plays a very important role in regulating novel virulence factor(s) of V. vulnificus associated with cytotoxicity other than hemolysin and protease during the infection process.
Alcohol Drinking ; Animals ; Clone Cells ; Exotoxins ; Genome ; HeLa Cells ; Humans ; Mice ; Phosphotransferases ; Signal Transduction* ; Vibrio vulnificus* ; Vibrio* ; Virulence*

Vibrio vulnificus is an estuarine bacterium that opportunistically infects humans with underlying hepatic diseases, heavy alcohol drinking habits, and other immunocompromised conditions. A locus in the V. vulnificus genome was cloned and sequenced, which showed similarities to the bacterial two-component signal transduction system. The locus encoded a putative sensor kinase, designated vvgS, and a divergently transcribed putative response regulator, designated vvgR. VvgS was predicted to be a protein belonging to the tripartite hybrid sensor kinase subfamily such as ArcB and BvgS. VvgR showed similarities to well known response regulators. An insertional mutation of vvgS in a V. vulnificus strain led to a remarkable decrease of cytotoxicity to HeLa cells, while the production of exotoxins, the hemolysin and the protease, slightly increased by the vvgS mutation. Adhesion to HeLa cells only slightly decreased. However, the vvgS mutation had no effect on the motility of V. vulnificus. The vvgS mutation resulted in a significant decrease of lethality to mice. These results indicate that vvgRS two-component system plays a very important role in regulating novel virulence factor(s) of V. vulnificus associated with cytotoxicity other than hemolysin and protease during the infection process.
Alcohol Drinking ; Animals ; Clone Cells ; Exotoxins ; Genome ; HeLa Cells ; Humans ; Mice ; Phosphotransferases ; Signal Transduction* ; Vibrio vulnificus* ; Vibrio* ; Virulence*

Aggregatibacter aphrophilus is a facultatively anaerobic gram-negative coccobacillus or bacillus that grows with no dependence on X factor and variable requirement for V factor. The organism is normal flora in the human oral cavity and upper respiratory tract and, rarely, causes invasive infections such as bacteremia, endocarditis, brain abscess, or osteomyelitis. We report a case of septic peripheral embolism in left leg from A. aphrophilus endocarditis. A 49-year-old man with known hypertension presented with acute muscle pain in the left leg. On physical examination, a regular heartbeat with a pansystolic murmur was heard. There were decreased pulses in the left popliteal and dorsalis pedis arteries and coldness of the left foot, although sensory and motor functions were intact. Angiography revealed an embolus in a branch of the left femoral artery. He underwent emergency embolectomy, and gram-negative bacilli grew in the embolus cultures. The same microorganism was isolated in two pairs of blood culturs and subsequently identified as A. aphrophilus. Transthoracic echocardiography revealed mitral regurgitation and multiple vegetations on the mitral valve. The patient was treated with a third-generation cephalosporin for 4 weeks and mitral valve replacement in view of the diagnosis of infective endocarditis and septic peripheral embolism.
Angiography ; Arteries ; Bacillus ; Bacteremia ; Brain Abscess ; Cold Temperature ; Echocardiography ; Embolectomy ; Embolism ; Embolism and Thrombosis ; Emergencies ; Endocarditis ; Femoral Artery ; Foot ; Humans ; Hypertension ; Leg ; Middle Aged ; Mitral Valve ; Mitral Valve Insufficiency ; Mouth ; Muscles ; Osteomyelitis ; Physical Examination ; Respiratory System

Live Vibrio vulnificus is highly cytotoxic to host cells in vivo and in vitro. The two most representative cytotoxins, cytolytic hemolysin and elastolytic protease, have been regarded to play major roles in the cytotoxicity of V. vulnificus. To further determine roles of the two cytotoxins in V. vulnificus pathogenesis, we constructed a double mutant of vvhA and vvpE genes, encoding a hemolysin and a protease, respectively. However, the cytotoxicity and the LD50 of a vvhA/vvpE double mutant showed no significant difference from those of the isogenic wild type strain. From these results, we came to speculate that yet unidentified, key cytotoxic factors should play a major role in the cytotoxic activity of V. vulnificus. The HeLa cells encountered with V. vulnificus became rounded, following detachment from the bottom of culture plate, and were killed eventually. However, the bacterial culture supernatant did not show any effect on the morphology and viability of HeLa cells. Also, no cytotoxicity could be noted when V. vulnificus was not allowed to contact with HeLa cells in the TranswellR system. Chloramphenicol, at lower concentration than minimum inhibitory concentration (MIC), decreased the cytotoxicity of a vvhA/vvpE double mutant to HeLa cells in a dose dependent manner. These results suggest that close encounter of V. vulnificus with host cells is a prerequisite to the cytotoxicity and that a yet unidentified virulence factor (s) should play an important role in the contact-dependent cytotoxicity.
Chloramphenicol ; Cytotoxins ; HeLa Cells ; Humans ; Lethal Dose 50 ; Microbial Sensitivity Tests ; Vibrio vulnificus ; Virulence*

This study was conducted to analyze traditional aspects of school lunch menus in Korea. We conducted a content analysis of menu-related contents included in guidelines for school lunch programs provided by 16 city and provincial education offices. In addition, the data of 10,495 menus for the third week of December 2010 and March, July, October 2011 from 557 elementary, middle, and high school were analyzed by school grade, area, and province. The results showed that there were no specific and detailed guidelines for menu planning in terms of traditional food culture in most of the guidelines for school lunch programs. However, the basic traditional menu composition was maintained in school lunch menus. The percentage of menus including rice and Kimchi was 97% and 95%, respectively, and that including Korean soup was about 72%. However, the frequency of serving Namul, Korean seasoned vegetable dish, accounted for only about 52% of the menus. The percentage of the menus following the traditional food group pattern including such five food groups as rice, Korean soup, Kimchi, Namul, and optional Korean side dish was only about 35%. The percentage of the menus following the traditional food group pattern excluding Namul from the five food groups accounted for about 30%. The traditional food group score, calculated by allocating 1 point to each of the five food groups was 4.06 out of 5 points on average. Elementary schools and schools in rural area and in Jeolla-do province served traditional menus more frequently. In conclusion, school lunch programs need to consider establishing traditional foods-based standards and relevant guidelines for school lunch, particularly for high schools and schools in urban areas and in some provinces.
Humans ; Korea ; Lunch ; Menu Planning ; Seasons ; Vegetables

Objectives: The purpose of this study was to compare the fracture strength and traslucency of 3D printing resin crowns according to different thicknesses. Methods: Resin crowns were designed with CAD software and a 3D scanner, using scanned data of the #61 tooth model. Resin Crowns with different thicknesses were printed using a 3D printer, and subsequently divided into four groups according to thickness (0.3, 0.5, 0.7, and 1.0 mm). Fracture strength was compared among groups with a resin strip crown of 1.0 mm thickness. Compressive force was applied using a universal testing machine at 30° along the lingual surface at 1 mm/min cross head speed. For translucency evaluation, thin square specimens were printed of thicknesses 0.3, 0.5, 0.7, and 1.0 mm, and translucency was measured using a spectrophotometer. Results: As a result of fracture strength measurement, fracture strength increased as thickness increased, and a significant difference was observed solely between thicknesses of 0.3 and 0.5 mm, and the thicknesses of 0.3 and 0.5 mm (P<0.05). Translucency decreased as thickness increased, and similarly, a significant difference was observed only between thicknesses of 0.3 and 0.5 mm and the thicknesses of 0.7 and 1.0 mm (P<0.05). Conclusions A 3D printing resin crown can be used as a clinical option for restoring a primary anterior tooth affected by caries.

Among the exotoxins produced by V. vulnificus, hemolysin (HS) has been reported to be the most potent one. To investigate the factors up- or down-regulating HS production in the context of pathogenesis, we observed the effects of salinity or/and temperature shifting, glucose, and acidic pH on the production of HS by V. vulnificus C7184 strain in vitro. Significantly more HS was produced when V. vulnificus was cultured in 0.9% salinity and 37 degrees C than in 2.5% and 25 degrees C. When the culture condition reflecting natural habitat of V. vulnificus (2.5% salinity and 25degrees C) was changed into that reflecting human body (0.9% salinity and 37 degrees C), 2.5 fold or more HS was produced than in the V. vulnificus being cultured continuously in 0.9% NaCl at 37 degrees C. This result suggests that V. vulnificus somehow recognizes the shifting in salinity and temperature and stimulate HS production. Glucose addition in the culture medium resulted in a dose- dependent decrease in the HS production. Glucose itself and acidic pH resulting from its metabolism both appeared to inhibit the HS production. Glucose in itself had more dominant role in suppressing the HS production than the lowered pH accompanying the metabolism of glucose. This result suggests that HS production is down-regulated in the presence of glucose and under environmental acidic pH.
Ecosystem ; Exotoxins ; Glucose* ; Human Body ; Hydrogen-Ion Concentration ; Metabolism ; Salinity* ; Vibrio vulnificus* ; Vibrio* ; Virulence

BACKGROUND/AIMS: Second-look endoscopy is performed to check for the possibility of post-endoscopic submucosal dissection (ESD) bleeding and to perform prophylactic hemostasis in most hospitals; however, there is little evidence about the efficacy of second-look endoscopy. We investigated whether second-look endoscopy after ESD is useful in the prevention of post-ESD bleeding. METHODS: A total of 550 lesions with gastric epithelial neoplasms in 502 patients (372 men and 130 women) were treated with ESD between August 18, 2009 and August 18, 2010. After the exclusion of three lesions of post-ESD bleeding within 24 hours, 547 lesions (335 early gastric cancers and 212 gastric adenomas) were included for the final analysis. RESULTS: The occurrence rate of delayed post-ESD bleeding was not significantly different between the second-look group and the no second-look group (1% vs 2.5%, p>0.05). The only predictor of delayed bleeding was tumor size, regardless of second-look endoscopy after ESD (22.8+/-9.87 vs 15.1+/-10.47, p<0.05). There was no difference between the prophylactic hemostasis and nonprophylactic hemostasis groups, including the occurrence rate of delayed bleeding. In the second-look group with prophylactic hemostasis, the hospital stay was more prolonged than in the second-look group without prophylactic hemostasis, but there was no significant difference (p=0.08). CONCLUSIONS: Second-look endoscopy to prevent delayed bleeding after ESD provides no significant medical benefits.
Adult ; Aged ; Aged, 80 and over ; Female ; Gastrectomy/adverse effects ; Gastric Mucosa/surgery ; *Gastroscopy ; Humans ; Length of Stay ; Male ; Middle Aged ; Postoperative Hemorrhage/*diagnosis/etiology ; Retrospective Studies ; Risk Factors ; Second-Look Surgery ; Stomach/pathology/surgery ; Stomach Neoplasms/pathology/*surgery ; Time Factors

PURPOSE: This study aimed to identify multidimensional factors influencing burnout in intensive care unit(ICU) nurses. METHODS: A descriptive cross-sectional design was used. Data were collected during February 2016 from a convenience sample of 222 tertiary hospital ICU nurses and analyzed using t-test, ANOVA, correlation analysis, and multiple regression analysis. RESULTS: Burnout correlated positively with compassion fatigue (CF)(r=.37, p < .001), and negatively with compassion satisfaction (CS)(r=-.66, p < .001). The regression model explained 57% of the variance in burnout. For individual characteristics in the model, perceived health status (β=-.27, p < .001) and gender (β=.14, p=.028) were the most influential factors for ICU nurses' burnout. In the model with added work-related characteristics, nursing environment (β=-.22, p=.001), perceived health status (β=-.20, p=.001), and satisfaction with department (β=-.19, p=.007) were the most influential factors. Finally, for the model with psychological characteristics added, CS (β=-.56, p < .001) and CF (β=.35, p < .001) were the most influential factors. CONCLUSION: Results reveal that most ICU nurses have a moderate level of CF and a moderate to high level of CS and burnout, and that individual, work-related and psychological factors are relevant in ICU nurses' burnout. Programs or interventions to reduce burnout should be developed taking into account these multidimensional factors.
Compassion Fatigue ; Critical Care ; Empathy ; Intensive Care Units ; Nursing ; Personal Satisfaction ; Psychology ; Tertiary Care Centers