OBJECTIVE: This study was organized to find out whether there are differences between pregravid weight, body mass index, weight gain during pregnancy and birth weight in 1989 and 1999. Also it was designed to find out the factors which influenced the birth weight changes. METHODS: A total of 725 (313 in 1989, 412 in 1999) pregnant women who had term delivery in the department of Obstetrics and Gynecology, Hanyang University Hospital were recruited for the study. Pregravid weight, body mass index, weight gain during pregnancy, body weight at the time of delivery and birth weight were examined through medical records retrospectively. RESULTS: Pregnant women in 1999 were older (29.7 +/- 3.7 yr vs 28.3 +/- 3.2 yr, p=0.0001), pregravid weight (54.0 +/- 7.5 kg vs 50.7 +/- 5.5 kg, p=0.0001), height (159.6 +/- 4.8 cm vs 158.5 +/- 4.7 cm, p=0.002), body mass index (21.2 +/- 2.8 kg/m2 vs 20.2 +/- 2.1 kg/m2, p=0.0001), weight gain during pregnancy (13.6 +/- 4.8 kg vs 12.8 +/- 4.6 kg, p=0.016) and birth weight (3103 +/- 652 gm vs 2993 +/- 843 gm, p=0.025) compared with those in 1989. The frequency of overweight (BMI>26) in pregravid was significantly higher in 1999 (9.4%) than in 1989 (1.9%) (p=0.0001). Weight gain during pregnancy were lower in over-weight pregravid than in normal or under-weight pregravid in both year, but birth weight was not different according to pregravid weight in both years. Compared to the weight gain during pregnancy less than 16 kg, women who gained weight more than 16 kg during pregnancy were significantly taller and weighed more at the time of delivery, and showed increased birth weight than those who gained weight during pregnancy less than 16 kg in both years. Weight gain during pregnancy was higher in over-weight pregravid than normal or under-weight pregravid in 1999 (p=0.012). The gain of body weight at the time of delivery in 1999 compared to those in 1989 is the most important factor for the birth weight change between two years. The increased pregravid weight, greater weight gain during pregnancy, and increased BMI also had an impact on the increasing birth weight in 1999. CONCLUSION: It is considered that physical characteristics of pregnant women in 1999 have been changed compared to those in 1989, and this change might be responsible for a birth weight increase.
Birth Weight ; Body Mass Index ; Body Weight ; Female ; Gynecology ; Humans ; Medical Records ; Obstetrics ; Overweight ; Pregnancy ; Pregnant Women ; Retrospective Studies ; Weight Gain ; Weights and Measures*

Orientia tsutsugamushi, a causative pathogen of Scrub typhus, is a gram-negative intracellular bacterium. Outer membrane vesicles (OMVs) are produced from the membrane of bacteria and play many roles related to the survival of the pathogen. However, there have been no reports confirming whether O. tsutsugamushi indeed produce OMVs. O. tsutsugamushi boryong was cultured in ECV-304 cells for the purification of OMVs. Western blot analysis and immunoenrichment using anti-O. tsutsugamushi monoclonal antibody and electron microscopy were employed for identification and characterization of OMVs. We confirm the presence of OMVs derived from O. tsutsugamushi, and also found that those OMVs contain a major surface antigen of 56-kDa protein and variant immunogenic antigens.
Antibodies, Monoclonal/*immunology ; Antigens, Bacterial/*immunology ; Antigens, Surface/*immunology ; Cell Line ; Cell Membrane/immunology ; Humans ; Microscopy, Electron ; Orientia tsutsugamushi/*immunology/metabolism ; Scrub Typhus/diagnosis/microbiology ; Secretory Vesicles/*immunology

BACKGROUND: The conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum cesarean section (CS) often fails, resulting in intraoperative pain. Spinal anesthesia (SA) can provide a denser sensory block than ESA. The purpose of this prospective, non-blinded, parallel-arm, randomized trial was to compare the rate of pain-free surgery between ESA and SA following ELA for intrapartum CS. METHODS: Both groups received continuous epidural infusions for labor pain at a rate of 10 ml/h. In the ESA group (n = 163), ESA was performed with 17 ml of 2% lidocaine mixed with 100 µg fentanyl, 1 : 200,000 epinephrine, and 2 mEq bicarbonate. In the SA group (n = 160), SA was induced with 10 mg of 0.5% hyperbaric bupivacaine and 15 µg fentanyl. We investigated the failure rate of achieving pain-free surgery and the incidence of complications between the two groups. RESULTS: The failure rate of achieving pain-free surgery was higher in the ESA group than the SA group (15.3% vs. 2.5%, P < 0.001). There was no statistical difference between the two groups in the rate of conversion to general anesthesia; however, the rate of analgesic requirement was higher in the ESA group than in the SA group (12.9% vs. 1.3%, P < 0.001). The incidence of high block, nausea, vomiting, hypotension, and shivering and Apgar scores were comparable between the two groups. CONCLUSIONS: SA after ELA can lower the failure rate of pain-free surgery during intrapartum CS compared to ESA after ELA.
Analgesia* ; Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal* ; Bupivacaine ; Cesarean Section* ; Epinephrine ; Female ; Fentanyl ; Hypotension ; Incidence ; Labor Pain ; Lidocaine ; Nausea ; Pregnancy ; Prospective Studies* ; Shivering ; Vomiting

Atypical hemolytic uremic syndrome (HUS) in adults is a life-threatening disorder characterized by acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia, which is not related to E. coli. Digital gangrene is one of the grave signs in emergency medicine because it requires prompt evaluation and treatment. We describe a 37 year-old Thailand woman, initially treated for suspected Neisseria septicemia, who went on to develop renal complications, thrombocytopenia and hemolytic anemia, which made the diagnosis of atypical hemolytic uremic syndrome. The patient was complaining of dysesthesia on all extremities and severe pain in both legs. Serologically, she was diagnosed as systemic lupus erythematosus (SLE). She was treated with plasma exchanges using fresh frozen plasma, parenteral steroid, anticoagulant and antibiotics, successfully. This is the first report of digital gangrene complicated by atypical HUS in a patient with SLE in Korea.
Acute Kidney Injury ; Adult ; Anemia, Hemolytic ; Anti-Bacterial Agents ; Emergency Medicine ; Extremities ; Female ; Gangrene ; Hemolytic-Uremic Syndrome ; Humans ; Korea ; Leg ; Lupus Erythematosus, Systemic ; Neisseria ; Paresthesia ; Plasma ; Plasma Exchange ; Sepsis ; Thailand ; Thrombocytopenia

OBJECTIVE: To evaluate the epidemiologic change of patients with spinal cord injury who were admitted to a Rehabilitation Hospital, Yonsei University College of Medicine, during 1987-1996 and 2004-2008. METHODS: Medical records of 629 patients with spinal cord injury admitted to the Rehabilitation Hospital, Yonsei University College of Medicine, from 2004 to 2008 were collected and reviewed retrospectively. RESULTS: The male-to-female ratio decreased to 2.86:1, the mean age at injury increased, nontraumatic etiology increased, traffic accident remained to be the most common in traumatic spinal cord injury, and falling increased significantly. Tumor was the most common etiology in nontraumatic spinal cord injury, tetraplegia and incomplete injuries occurred more than paraplegia and complete injuries, indwelling catheter was the most common voiding method, and the duration of hospitalization decreased. CONCLUSION: Many trends changed in epidemiology of spinal cord injury.
Accidents, Traffic ; Catheters, Indwelling ; Hospitalization ; Humans ; Medical Records ; Paraplegia ; Quadriplegia ; Spinal Cord ; Spinal Cord Injuries

It has been reported that injection of Freund's complete adjuvant (FCA) into the hindpaw of a rat induces inflammatory responses with accompanying pain behaviors. Signs of pain behaviors observed in FCA-injected animals were reported to be similar to symptoms seen in patients with inflammatory pain. The nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) is a selective histochemical marker for the nitric oxide synthesizing enzyme, nitric oxide synthase (NOS). N (G)-nitro-L-arginine methyl ester (L-NAME) is a NOS inhibitor. In the present study, we examined if inflammaory pain causes increases in NADPH-diaphorase reactivities in neurons of the dorsal root ganglia (DRG). The results were as follows; 1. FCA-induced inflammation on a limb increased staining density (SD) of NADPH-d positive neurons in the ipsilateral side DRG. 2. Pretreatment of L-NAME did not changed SD of NADPH-d positive neurons on the inflammation of contralateral side DRG 3. Posttreatment of L-NAME decreased the inflammation induced SD of NADPH-d positive neurons. 4. n-NOS immunoreactivity did not match NADPH-d histochemical study, implying the constant level of enzyme itself. Inflammation pain on a hindlimb increased staining density of NADPH-diaphorase positive neuron in the DRG, which was decreased by L-NAME. L-NAME also decreased pain perception. This suggests a role of NO in the pain perception and/or modulation at the level of DRG.
Animals ; Diagnosis-Related Groups* ; Extremities ; Ganglia, Spinal ; Hindlimb ; Humans ; Inflammation ; NAD ; NADP ; Neurons ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase ; Nitric Oxide* ; Pain Perception ; Rats*

Coronavirus disease 2019 (COVID-19) is rapidly spreading around the world, causing much morbidity and mortality everywhere. However, effective treatments or vaccines are still not available. Although convalescent plasma (CP) therapy can be useful in the treatment of COVID-19, it has not been widely used in Korea because of the concerns about adverse effects and the difficulty in matching patients to donors. The use of ABO-incompatible plasma is not contraindicated in treatment, but can be hesitated due to the lack of experience of physicians. Here, we describe a 68-year old man with COVID-19 who was treated ABO-incompatible plasma therapy; additionally, we comment on the acute side effects associated with ABO mismatch transfusion. To overcome the obstacles of donor-recipient connections (schedule and distance), we propose the storage of frozen plasma, modification of the current Blood Management Law, and the establishment of a CP bank. We suggest that experience gained in CP therapy will be useful for not only the treatment of COVID-19, but also for coping with new emerging infectious diseases.

BACKGROUND/AIMS: Fecal microbiota transplantation (FMT) is a highly effective therapy for refractory and recurrent Clostridium difficile infection (CDI). Despite its excellent efficacy and recent widespread use, FMT has not been widely used in South Korea thus far. We describe our experience with FMT to treat refractory/recurrent CDI. METHODS: We conducted a chart review of patients who underwent FMT for refractory/recurrent CDI at Inha University Hospital, between March 2014 and June 2016. The demographic information, treatment data, and adverse events were reviewed. FMT was administered via colonoscopy and/or duodenoscopy. All stool donors were rigorously screened to prevent infectious disease transmission. RESULTS: FMT was performed in nine patients with refractory/recurrent CDI. All patients were dramatically cured. Bowel movement was normalized within one week after FMT. There were no procedure-related adverse events, except aspiration pneumonia in one patient. During the follow-up period (mean 11.4 months), recurrence of CDI was observed in one patient at one month after FMT due to antibiotics. CONCLUSIONS: FMT is a safe, well-tolerated and highly effective treatment for refractory/recurrent CDI. Although there are many barriers to using FMT, we expect that FMT will be widely used to treat refractory/recurrent CDI in South Korea.
Anti-Bacterial Agents ; Clostridium difficile* ; Clostridium* ; Colonoscopy ; Disease Transmission, Infectious ; Duodenoscopy ; Fecal Microbiota Transplantation* ; Follow-Up Studies ; Gastrointestinal Microbiome ; Humans ; Korea ; Pneumonia, Aspiration ; Recurrence ; Tissue Donors

Corynebacterium striatum is an aerobic, Gram-positive bacillus that is part of the resident flora of skin and mucosal membranes. C. striatum is usually considered a non-pathogenic contaminant, although infective endocarditis and respiratory infection, and less frequently arthritis and meningitis, due to C. striatum have been reported. C. striatum has been particularly associated with catheter-related infections and infections following conditions that resulted in disruption of the skin barrier in both immunocompromised and immunocompetent hosts. We describe a case of post-operative intra-abdominal infection caused by the rare pathogen, C. striatum.
Arthritis ; Bacillus ; Catheter-Related Infections ; Corynebacterium ; Endocarditis ; Intraabdominal Infections ; Membranes ; Meningitis ; Skin

This study was intended to investigate the sodium-related perception, dietary behavior, and practicability of methods for reducing sodium intake(RSI) according to the stage of change in consumers. The survey was conducted to 770 housewives, among them 553 subjects who answered the key questions for the stage of change were categorized into ''aintenance (M)' stage (maintaining reduced salt intake for more than 6 months; n = 287, 51.90%), 'Action (A)' stage (maintaining reduced salt intake for less than 6 months; n=139, 25.14%), and 'Pre-Action (P)'stage (not starting reduced salt intake; n = 127, 22.97%). The subjects in M and A were significantly older than those in P (p < 0.01). The scores of desirable dietary habit and dietary balance were the highest in M followed by A and P. When eating out, the subjects in P considered 'price' more and 'healthiness of food' less than those in M and A did. Among the guidelines for RSI, 'Avoid Processed Foods', 'Eat enough vegetables and fruits' and 'Add little amount of dipping sauce for fried food' were selected as the three easiest items to perform. With regard to the sodium-related perception, the subjects in M considered eating-out food to be more salty than homemade dishes, read nutrition labels more, avoided table salt or dipping sauce for fried food more, and had 'own low-sodium recipe' than those in P (p < 0.001). It is suggested that practicability of actions for RSI and the stage of change should be considered to develop effective personalized education program and nutrition guidance.
Eating ; Food Habits ; Humans ; Sodium ; Sodium Chloride, Dietary ; Vegetables