Crohn's disease, a chronic relapsing, multisystemic, inflammatory disorder, may involve any part of the gastrointestinal tract and shows a cobblestone-like appearance on intestinal mucosa. There are also extraintestinal features, including lesions of the skin, eye, and joints. Ulcers, fissures, sinus tracts, abscesses, and vegetant plaques have been reported for the perianal skin lesions of Crohn's disease. We experienced a case of Crohn's disease in a 21-year-old Korean female showing a skin lesion with a cobblestone-like appearance in the perianal region.
Abscess ; Crohn Disease* ; Female ; Gastrointestinal Tract ; Humans ; Intestinal Mucosa ; Joints ; Skin* ; Ulcer ; Young Adult

PURPOSE: This study aimed to analyze the mobility of newly graduated nurses from regions where their nursing schools were located to regions where they took up their first jobs, and to identify factors influencing nurses' mobility. METHODS: Data from the Graduates Occupational Mobility Survey, collected annually from 2010 to 2014 by the Korea Employment Information Service, were analyzed. The sample consisted of 1,488 graduates and 1,229 nurses who were employed on a full-time basis in hospitals. Multiple logistic regression analysis was conducted to identify factors associated with geographic mobility. RESULTS: Among the nurses working in hospitals, 69.2% had their first jobs in their nursing school regions and 11.3% in their high school regions. Fifty-two percent of the nurses worked in the capital region; 47.2% thereof had moved from a non-capital region. Nurses were more likely to work in their nursing school region when they were female, were older, graduated from a high school located in their nursing school region, graduated from a college (vs. university), had a lower nursing school performance, and expected lower monthly wage, compared with those who left their nursing school region. CONCLUSION: Education and remuneration policies are required to reduce geographical mobility to the capital region.
Education ; Employment ; Female ; Humans ; Information Services ; Korea ; Logistic Models ; Professional Practice Location ; Remuneration ; Salaries and Fringe Benefits ; Schools, Nursing

In this study, we have conducted characterization of imaging performance for a flat panel digital X-ray detector using amorphous Selenium and a-Si TFT which was developed by the authors. The procedures for characterization were in concordance with internationally recommended standards such as IEC (international electrotechnical commission). The measures used for imaging performance characterization include response characteristic, modulation transfer function (MTF), detective quantum efficiency (DQE), noise power spectrum (NPS), and quantum limited performance. The measured DQEs at lowest and highest spatial frequencies were 40% and 25% respectively, which was superior to that of commercial products by overseas vendor. The MTF values were significantly superior to that of CR and indirect type DRs. The quantum limited performance showed the detector was limited by quantum noise at the entrance exposure level below 0.023 mR, which is sufficiently low for general X-ray examination.
Commerce ; Noise ; Selenium ; Silicon

We attempted to investigate the effects of curricular change on a basic medical science, anatomy, based on academic achievements including Basic Medical Education Examination (BMEE). We performed an analysis between the academic years of 2011 and 2012. Independent-samples t-test for the academic achievements, paired-samples t-test for the promotion, and correlation analysis for the related subcategory of the anatomy based on the results of BMEE, which was done with SPSS 22.0. In this follow-up study for two academic years, the academic achievements decreased as the students went to the next grade under the changed curriculum of anatomy. The academic achievements decreased as the students went to the next grade in the academic year 2012 while it increased in 2011 (p<0.01). Although averages of school evaluations were similar between the academic years, the academic achievements were different from each other: it was higher in first BMEE for 2012, and in second BMEE for 2011 (p<0.05). Although the correlation was not found among school evaluations, first and second BMEE of 2011, the associations were seen both between school evaluations (p<0.01) and each BMEE (p<0.05), respectively, in 2012. These results suggested that professors of medical school should continue to lead the direction of the curriculum improvement and management depending on the academic achievement, and also to monitor all the processes, maintaining a quality of the assessment system although it might be difficult to be representative or generalize for all medial schools.
Curriculum ; Education, Medical* ; Educational Measurement ; Follow-Up Studies ; Humans ; Schools, Medical

Purpose: This study aimed to determine the effects of grit, nursing work environment, and job esteem on the intent to stay among military hospital nurses. Methods: This study employed a descriptive cross-sectional design. Data were collected from February 7 to 18, 2022 from 232 nurses working at four military hospitals under the Armed Forces Medical Command. The analysis was conducted using the SPSS/WIN 26.0 program, and descriptive statistics, t-test, ANOVA, Pearson coefficient correlations, and multiple regression analysis were performed. Results: Factors affecting the intent to stay included job esteem (β=.44, p<.001), total clinical experience of more than 10 years (β=.24, p=.001), and nursing work environment (β=.17, p=.009). Conclusion The results can be used to ensure personnel quality at military medical institutions and can contribute to improving patient safety and medical services. Further, nursing managers need to formulate and implement strategies to foster a positive nursing work environment.

Objective: To investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) and its role as a second-line imaging modality after gadoxetate-enhanced MRI (Gd-EOB-MRI) in the diagnosis of hepatocellular carcinoma (HCC) among at risk observations. Materials and Methods: We prospectively enrolled participants at risk of HCC with treatment-naïve solid hepatic observations (≥ 1 cm) of Liver Imaging Reporting and Data System (LR)-3/4/5/M during surveillance and performed Gd-EOB-MRI. A total of one hundred and three participants with 103 hepatic observations (mean size, 28.2 ± 24.5 mm; HCCs [n = 79], non-HCC malignancies [n = 15], benign [n = 9]; diagnosed by pathology [n = 57], or noninvasive method [n = 46]) were included in this study. The participants underwent CEUS with sulfur hexafluoride. Arterial phase hyperenhancement (APHE) and washout on Gd-EOB-MRI and CEUS were evaluated. The distinctive washout in CEUS was defined as mild washout 60 seconds after contrast injection. The diagnostic ability of Gd-EOB-MRI and of CEUS as a second-line modality for HCC were determined according to the European Association for the Study of the Liver (EASL) and the Korean Liver Cancer Association and National Cancer Center (KLCA-NCC) guidelines. The diagnostic abilities of both imaging modalities were compared using the McNemar’s test. Results: The sensitivity of CEUS (60.8%) was lower than that of Gd-EOB-MRI (72.2%, p = 0.06 by EASL; 86.1%, p < 0.01 by KLCA-NCC); however, the specificity was 100%. By performing CEUS on the inconclusive observations in Gd-EOB-MRI, HCCs without APHE (n = 10) or washout (n = 12) on Gd-EOB-MRI further presented APHE (80.0%, 8/10) or distinctive washout (66.7%, 8/12) on CEUS, and more HCCs were diagnosed than with Gd-EOB-MRI alone (sensitivity: 72.2% vs. 83.5% by EASL, p < 0.01; 86.1% vs. 91.1% by KCLA-NCC, p = 0.04). There were no false-positive cases for HCC on CEUS. Conclusion The addition of CEUS to Gd-EOB-MRI as a second-line diagnostic modality increases the frequency of HCC diagnosis without changing the specificities.

Purpose: This study investigated whether the use of ultrasound (US) guidance in transient elastography (TE) improved the technical success and reliability of liver stiffness (LS) measurements and whether 2-dimensional (2D) shear wave elastography (SWE) provided reliable LS measurements if TE measurements failed. Methods: In this prospective study, 292 participants (male:female, 189:103; median age, 60 years) with chronic liver disease (CLD) were enrolled. LS was measured via the consecutive use of conventional TE, 2D-SWE, and US-guided TE. The technical success rates and reliable LS measurement rates of the three elastography techniques were compared. The risk factors for TE failure were assessed through univariate and multivariate logistic regression models. Results: US-guided TE was associated with a higher technical success rate (281 of 292, 96.2%) and a higher reliable measurement rate (266 of 292, 91.1%) than conventional TE (technical success: 256 of 292, 87.7%; reliable measurements: 231 of 292, 79.1%; P<0.001 for both). In participants for whom conventional TE failed, 2D-SWE provided high rates of technical success (36 of 36, 100%) and reliable measurements (30 of 36, 83.3%). TE failure was associated with female sex (odds ratio [OR], 5.85; 95% confidence interval [CI], 1.30 to 26.40), severe reverberation artifacts (OR, 8.79; 95% CI, 3.93 to 19.69), and high skin-to-liver capsule depth (OR, 1.23; 95% CI, 1.09 to 1.39). Conclusion US guidance in TE improved the technical success and reliable measurement rates in the assessment of LS in patients with CLD. In participants for whom TE failed, subsequent 2D-SWE successfully delivered reliable LS measurements.

Adult ; Anti-Bacterial Agents ; Communicable Diseases ; Debridement ; Early Diagnosis ; Extremities ; Fascia ; Fasciitis, Necrotizing ; Gangrene ; Head ; Humans ; Male ; Mortality ; Neck ; Necrosis ; Perineum ; Subcutaneous Tissue

BACKGROUND: In recent years, the incidence of extended-spectrum beta-lactamase (ESBL) producing Klebsiella has been steadily increased, and the newer species K. planticola and K terrigena, formerly regarded as nonpathogen, have been reported with astonishing frequency from human infectious processes by some investigators. The aim of this study is to elucidate the isolation rate and antimicrobial susceptibility of recent clinical Klebsiella isolates. METHOD: For the clinical Klebsiella isolates during the period of June 1999 to May 2000, isolation frequency of Klebsiella species by specimen, departments, age, and sex were analyzed. And antimicrobial susceptibilities were also analyzed. RESULT: Isolation rate of Klebsiella in order of decreasing frequency were K. pneumoniae (74:7%), K. oxytoca (12.1%), K. ozaenae(1.7%), K. planticola(1.0%), K. terngena(0.9%), and K, ornithinolytica (0.7%), respectively. K. rhinoscleromatis was not isolated. Compared with outpatients, increase of resistance rates of inpatients's Klebsiella isolates were 10% in ciprofloxacin, 15% in cefoperazone/sulbactam, and the others were ranged from 24% to 31%. Isolation rate of ESBL producing K. pneumoniae by double disk (DD) synergy test was 41%, and detection rates by antimicrobial agents were as follows: cefotaxime (95%), aztreonam (58%), and ceftriaxone (37%). Antimicrobial susceptibility rate with the exception of ampicillin and imipenem decreased from the range of 81%-96% on admission day to 29-62% after one week on admission. CONCLUSION: The isolation rates of K. planticola and K. terrigena were less than 1%. The proportion of ESBL producing K. pneumoniae was 41 %. And the vast majority of multidrug resistant Klebsiella including ESBL producing strains are acquired by hospitalization.
Ampicillin ; Anti-Infective Agents ; Aztreonam ; beta-Lactamases ; Cefotaxime ; Ceftriaxone ; Ciprofloxacin ; Epidemiology* ; Hospitalization ; Humans ; Imipenem ; Incidence ; Klebsiella pneumoniae ; Klebsiella* ; Outpatients ; Pneumonia ; Research Personnel

BACKGROUND: In recent years, the incidence of extended-spectrum beta-lactamase (ESBL) producing Klebsiella has been steadily increased, and the newer species K. planticola and K terrigena, formerly regarded as nonpathogen, have been reported with astonishing frequency from human infectious processes by some investigators. The aim of this study is to elucidate the isolation rate and antimicrobial susceptibility of recent clinical Klebsiella isolates. METHOD: For the clinical Klebsiella isolates during the period of June 1999 to May 2000, isolation frequency of Klebsiella species by specimen, departments, age, and sex were analyzed. And antimicrobial susceptibilities were also analyzed. RESULT: Isolation rate of Klebsiella in order of decreasing frequency were K. pneumoniae (74:7%), K. oxytoca (12.1%), K. ozaenae(1.7%), K. planticola(1.0%), K. terngena(0.9%), and K, ornithinolytica (0.7%), respectively. K. rhinoscleromatis was not isolated. Compared with outpatients, increase of resistance rates of inpatients's Klebsiella isolates were 10% in ciprofloxacin, 15% in cefoperazone/sulbactam, and the others were ranged from 24% to 31%. Isolation rate of ESBL producing K. pneumoniae by double disk (DD) synergy test was 41%, and detection rates by antimicrobial agents were as follows: cefotaxime (95%), aztreonam (58%), and ceftriaxone (37%). Antimicrobial susceptibility rate with the exception of ampicillin and imipenem decreased from the range of 81%-96% on admission day to 29-62% after one week on admission. CONCLUSION: The isolation rates of K. planticola and K. terrigena were less than 1%. The proportion of ESBL producing K. pneumoniae was 41 %. And the vast majority of multidrug resistant Klebsiella including ESBL producing strains are acquired by hospitalization.
Ampicillin ; Anti-Infective Agents ; Aztreonam ; beta-Lactamases ; Cefotaxime ; Ceftriaxone ; Ciprofloxacin ; Epidemiology* ; Hospitalization ; Humans ; Imipenem ; Incidence ; Klebsiella pneumoniae ; Klebsiella* ; Outpatients ; Pneumonia ; Research Personnel