PURPOSE: The symptoms and signs of urinary tract infection (UTI) in early infancy are non-specific. Prompt diagnosis of UTI is important, as untreated UTI results in renal damage. Especially, febrile UTI in young infants coexist with other serious bacterial infections. The purpose this study was to propose modified Rochester criteria to differentiate viral infection from urinary tract infection. METHODS: We carried out a retrospective investigation of 168 infants less than three months old with a tympanic temperature >38degrees C who were admitted to Chung-Ang University Hospital between 2011 and 2014. We compared the symptoms, physical examination results, and laboratory data between viral infection and UTI groups. A modified Rochester criterion was composed of statistically significant factors. RESULTS: A total of 76 and 92 infants with UTI and a viral infection, respectively, were included. Statistically significant differences in gender, previous admission history, neutrophil ratio, and urine WBC count were found between the two study groups. Using a cut off value of 3 points, the sensitivity and specificity of the modified Rochester criteria were 71.28% and 78.57%, respectively. CONCLUSION: The modified Rochester criteria may give an outline for identifying young infants with UTI.
Bacterial Infections ; Diagnosis ; Humans ; Infant* ; Neutrophils ; Physical Examination ; Retrospective Studies ; Sensitivity and Specificity ; Urinary Tract Infections* ; Urinary Tract*

OBJECTIVE: This study evaluates the effect of the specific human papillomavirus (HPV) genotype as a prognostic factor in stage I-IIA cervical cancer patients following primary surgical treatment. METHODS: The medical records of 116 cervical cancer patients treated with primary surgical treatment were reviewed. The HPV genotypes were categorized into following groups: negative and unclassified, HPV 16, HPV 18, and other high risk (HPV 31, 33, 35, 45, 51, 52, 56, and 58). RESULTS: Among the HPV genotypes, HPV 16 predominated (40.52%), followed by intermediate risk and unclassified (25%), HPV 18, 45, and 56 (17.24%) and negative (17.24%). In univariate analysis, HPV genotypes (P=0.03), parametrial spread (P=0.02), depth of invasion (DOI) (P<0.01) and lymph-vascular space invasion (P=0.02) were significantly associated with progression free survival (PFS). In multivariate analysis, HPV 18 (hazard ratio [HR], 5.2; 95% confidence interval [CI], 1.29 to 20.90; P=0.02) and > or =one half of DOI (HR, 5.4; 95% CI, 1.08 to 27.31; P=0.04) were significantly associated with PFS. HPV genotypes are not significantly associated with overall survival. CONCLUSION: HPV 18 was a poor prognostic factor for the PFS in stage I-IIA cervical cancer patients following primary surgical treatment. Careful long-term observation and regular exams are recommended for cervical cancer patients with HPV 18 compared to those with other HPV genotypes.
Disease-Free Survival ; Genotype ; Human papillomavirus 16 ; Human papillomavirus 18* ; Humans ; Medical Records ; Multivariate Analysis ; Prognosis ; Uterine Cervical Neoplasms*

PURPOSE: The aim of this study was to design an intraoral environment simulator and to assess the accuracy of two intraoral scanners using the simulator. MATERIALS AND METHODS: A box-shaped intraoral environment simulator was designed to simulate two specific intraoral environments. The cast was scanned 10 times by Identica Blue (MEDIT, Seoul, South Korea), TRIOS (3Shape, Copenhagen, Denmark), and CS3500 (Carestream Dental, Georgia, USA) scanners in the two simulated groups. The distances between the left and right canines (D3), first molars (D6), second molars (D7), and the left canine and left second molar (D37) were measured. The distance data were analyzed by the Kruskal-Wallis test. RESULTS: The differences in intraoral environments were not statistically significant (P>.05). Between intraoral scanners, statistically significant differences (P < .05) were revealed by the Kruskal-Wallis test with regard to D3 and D6. CONCLUSION: No difference due to the intraoral environment was revealed. The simulator will contribute to the higher accuracy of intraoral scanners in the future.
Georgia ; Molar ; Seoul

OBJECTIVE: Emergency department (ED) visits by nonurgent patients are controversial because they are considered one of the causes of ED overcrowding and an example of the improper use of medical resources. On the other hand, some non-urgent patients do require hospitalization. The purpose of this study was to compare hospitalized and discharged patients who were classified as nonurgent upon their initial ED visit and identify the predictive factors associated with hospitalization in nonurgent patients visiting an ED. METHODS: Among a nonurgent patient group visiting an urban university hospital ED in 2016, the hospitalized and discharged patients were compared. RESULTS: A total of 13,988 nonurgent patients were analyzed, of which 773 (5.5%) were hospitalized. The predictive factors related to hospitalization for nonurgent patients were as follows: male, age 65 years or older, ED visits during outpatient clinic availability, and in the evening, heart rate greater than 100 per minute, respiration rate greater than 20 per minute and body temperature over 38℃ CONCLUSION: Among nonurgent patients, there are patients who require hospitalization. If these predictive factors are considered in the initial ED triage, it should improve the safe treatment of nonurgent patients and improve the efficiency of the use of limited resources.
Ambulatory Care Facilities ; Body Temperature ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Hand ; Heart Rate ; Hospitalization* ; Hospitals ; Humans ; Male ; Respiratory Rate ; Triage

Listeria monocytogenes is a rare cause of bacterial meningitis, particularly beyond the neonatal period. This article describes a 16-month-old girl who presented with a new-onset febrile status epilepticus, and subsequently developed altered mentality and lethargy. L. monocytogenes was detected on a point-of-care, multiplex polymerase chain reaction using the cerebrospinal fluid. On day 3, she developed a rapidly progressive hydrocephalus. Her consciousness improved after placement of an external ventricular drain. After 3-week antibiotic therapy, she was successfully discharged without residual complications.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare disease. The prognosis is poor in most cases with rapid progression despite administering chemotherapy. A 67-year-old man complained of skin rashes on his back and this spread to the trunk, face, arms and thighs, and he was initially diagnosed with cutaneous lupus erythematosus according to the skin biopsy. The skin rashes then became aggravated on a trial of low dose methylprednisolone for 3 months. Repeated skin biopsy revealed a diffuse infiltration of lymphoid cells with medium sized nuclei, positive for CD4 and CD56, negative for Epstein-Barr virus (EBV), indicating a diagnosis of BPDCN. Further workups confirmed stage IVA BPDCN involving the skin, multiple lymph nodes, the peripheral blood and the bone marrow. He was treated with six cycles of combination chemotherapy consisting of ifosphamide, methotrexate, etoposide, prednisolone and L-asparaginase, and he achieved a partial response. Herein we report on a rare case of BPDCN that was initially misinterpreted as cutaneous lupus erythematosus.
Aged ; Arm ; Biopsy ; Bone Marrow ; Dendritic Cells ; Drug Therapy, Combination ; Etoposide ; Exanthema ; Herpesvirus 4, Human ; Humans ; Lupus Erythematosus, Cutaneous ; Lymph Nodes ; Lymphocytes ; Methotrexate ; Methylprednisolone ; Prednisolone ; Prognosis ; Rare Diseases ; Skin ; Thigh

TNF-alpha, a proinflammatory cytokine, inhibits osteoblast differentiation under diverse inflammatory conditions; however, the underlying mechanisms in terms of the TNF-alpha signaling pathway remain unclear. In this study, we examined the role of Msx2 in TNF-alpha-mediated inhibition of alkaline phosphatase (ALP) expression and the signaling pathways involved. TNF-alpha down-regulated ALP expression induced by bone morphogenetic protein 2 (BMP2) in C2C12 and Runx2-/- calvarial cells. Over-expression of Msx2 suppressed BMP2-induced ALP expression. Furthermore, TNF-alpha induced Msx2 expression, and the knockdown of Msx2 by small interfering RNAs rescued ALP expression, which was inhibited by TNF-alpha. TNF-alpha activated the NF-kappaB and the JNK pathways. Inhibition of NF-kappaB or JNK activation reduced the inhibitory effect of TNF-alpha on ALP expression, whereas TNF-alpha-induced Msx2 expression was only suppressed by the inhibition of the NF-kappaB pathway. Taken together, these results indicate that Msx2 mediates the inhibitory action of TNF-alpha on BMP2-regulated osteoblast differentiation and that the TNF-alpha-activated NF-kappaB pathway is responsible for Msx2 induction.
Alkaline Phosphatase/genetics/metabolism ; Animals ; Animals, Newborn ; Bone Morphogenetic Protein 2/pharmacology ; Cell Culture Techniques ; Cell Differentiation/*drug effects/genetics ; Cell Proliferation/drug effects ; Cells, Cultured ; Core Binding Factor Alpha 1 Subunit/genetics ; Down-Regulation/drug effects ; Gene Expression Regulation/drug effects ; Homeodomain Proteins/antagonists & inhibitors/genetics/*physiology ; Mice ; Mice, Inbred ICR ; Mice, Transgenic ; Osteoblasts/*drug effects/metabolism/physiology ; RNA, Small Interfering/pharmacology ; Tumor Necrosis Factor-alpha/*pharmacology

Apoptosis, including the programmed cell death, is important event in normal cell turnover and maintenance of adult tissues. Apoptosis exerts a homeostatic function in relation to tissues dynamics, as the steady state of continuously renewing tissues achieved by a balance between cell replication and cell death. This study was undertaken to investigate the association between apoptosis and development of the cervical neoplasia. Archival cervical samples from normal epithelium (n 10), low-grade squamous intraepithelial lesions (LSIL, n = 10), high-grade squamous intraepithelial lesions (HSIL, n 10), microinvasive squamous cell carcinomas (n 10), and invasive squamous cell carcinomas (n = 10) were evaluated for apoptosis. We used in situ end-labeling of DNA strand breaks by terminal deoxynucleotidyltransferase incorporation of biotinylated deoxyuridine to 3-OH ends of DNA, identified by nickel-avidine-peroxidase. The apoptotic index (sum of apoptotic bodies divided by the total nuclei times 100) significantly decreased (P<0.05) as the degree of neoplasia increased: 3.1 + 0.9 % in normal epithelium, 5.5 +/- 1.4 % in LSIL, 1.6 +/- 0.4 % in HSIL, 1.9 +/- 0.5 % in microinvasive carcinomas, and 0.6 +/- 0.3 % in invasive carcinomas. Compared to normal epithelium, the total cell number per 200x field increased significantly (P<0,05): 379 +/- 47 in normal epithelium, 462 +/- 228 in LSIL, 670+/-293 in HSIL, 1035 +/- 254 in microinvasive carcinomas, and 1389 +/- 247 in invasive carcinomas. Consequently, these results suggest that progession of cervical carcinogenesis is associated with a decrease in apoptotic index and an increase in the number of the total cell.
Adult ; Apoptosis* ; Carcinogenesis ; Carcinoma, Squamous Cell ; Cell Count ; Cell Death ; Deoxyuridine ; DNA ; DNA Nucleotidylexotransferase ; Epithelium ; Humans

PURPOSE: This study was done to evaluate the formal education program provided by the Korean government for care workers for frail elderly people. METHODS: This study was a cross-sectional survey in which 438 certified care workers who had completed the education program participated. Data were collected from June to October 2009, using a self-report questionnaire consisting of satisfaction with, and understanding of the education program. RESULTS: The participants had a mean age of 46.7 yr, 87.9% were female and 58.2% were high school graduates. For the theory part of the education, the highest score for understanding was for 'supporting household & activities of daily living' while the lowest score for understanding was for 'care for death and dying'. For the practical education, the highest score for understanding was for 'talking with the client' and the lowest score was for 'first aid & basic life support'. There was a significant difference in satisfaction and understanding of the theoretical and practical parts according to educational level. CONCLUSION: Continuing education programs are needed for care workers for elders, both in the theoretical and practical areas. Also the content of programs should address the weak points of this formal education program.
Adult ; Aged ; Caregivers/*education/psychology ; Cross-Sectional Studies ; Education, Nursing, Continuing ; Female ; Frail Elderly ; Humans ; Male ; Middle Aged ; Program Evaluation ; Questionnaires ; Republic of Korea

OBJECTIVES: Mastoid obliteration is used to obliterate the mastoid cavity following a mastoidectomy or to prevent the formation of a retraction pocket. This study evaluated the effectiveness of beta-tricalcium phosphate and polyphosphate (beta-TPP) for mastoid obliteration in middle ear surgeries in prospective human and animal studies. METHODS: Twenty patients with chronic otitis media underwent mastoid obliteration using beta-TPP after a intact canal wall mastoidectomy or simple mastoidectomy. The clinical data were prospectively evaluated including: the diagnosis, temporal bone computed tomography (TBCT), otoscopic findings, pure tone audiogram, and complications. In the animal experiment, beta-TPP was applied into the right bulla in five rats, and the opposite bulla was used as the control in the non-obliterated state. The skulls of five other rats were drilled out and the holes were obliterated with beta-TPP. TBCT were obtained at 3, 6, and 9 months after the obliteration and histologic analysis was done at 3 and 9 months after surgery. RESULTS: In the human study, fourteen TBCTs were obtained at 12 months after the surgery. All demonstrated no bone resorption in the obliterated mastoids. Among the 15 cases displaying retracted tympanic membranes preoperatively, 11 showed no retraction, 2 showed retraction postoperatively, 1 was lost to follow-up and 1 was a case of postoperative wound infection. Among 20 cases, one case developed a postoperative infection that necessitated a second operation. Sixteen underwent ossiculoplasty; hearing improvements were obtained in 15 cases and 1 case showed decreased hearing. In the animal study, new bone formation without significant bone resorption in the radiologic and histologic findings were noted in both the skull and bulla groups. CONCLUSION: Although beta-TPP is a foreign material having the possibility of infection, mastoid obliteration with it can be a treatment option in middle ear surgeries to prevent retraction pockets or the recurrence of diseases.
Animal Experimentation ; Animals ; Blister ; Bone Resorption ; Calcium Phosphates ; Cholesteatoma ; Ear, Middle ; Hearing ; Humans ; Lost to Follow-Up ; Mandrillus ; Mastoid ; Osteogenesis ; Otitis Media ; Prospective Studies ; Rats ; Recurrence ; Skull ; Surgical Wound Infection ; Temporal Bone ; Tympanic Membrane