The purpose of this study was to measure the marginal fidelities and the fracture strength of IPS Empress 2. and In-Ceram. ceramic crowns. After constructed of 12 experimental dies for each group, ceramic crowns were fabricated on the metal master dies prepared on the maxillary right premolar. Marginal gaps were measured on the specimen between the margin of each crown and finishing line of the metal master die by using stereo-microscope(SZ-ST. Olympus, Japan) and all specimens were cemented on the metal master die with Bistite II.(Tokuyama soda Co, LTD., Japan) resin cement. Finally, marginal gaps were measured again. To measure of the fracture strength, buccal incline on the functional cusp of specimens were loaded until the catastrophic failure occurred by using the AGS-1000 D.(Shimadzu, Japan). The result of marginal fidelities and fracture strength were statistically analyzed with the SPSS version 8.0 programs. The results of this study were as follows : 1. No significant difference was found in the mean marginal fidelities and fracture strength between the IPS Empress 2. and In-Ceram. 2. In comparison of marginal fidelities between before and after cementation, there was significant difference(P<0.05). The IPS Empress 2 system was shown in this study that had good marginal fidelities and fracture strength compared to In-Ceram ceramics. Although this system was acceptable to clinical applications, the system still has to be considered long-term researches about marginal fidelities and fracture strength due to the lack of data about the clinical researches.
Bicuspid ; Cementation ; Ceramics ; Crowns* ; Resin Cements

PURPOSE: The purpose of this study was to identify employment experiences of nurses caring for hospitalized foreign patients. METHODS: For this study, 10 nurses caring for foreign patients for more than 6 months were chosen purposively. Data were collected through in-depth individual interviews from July to September 2013 and analyzed in terms of Giorgi's phenomenological methodology. RESULTS: Five themes-clusters were identified from fifteen themes; 1) Awesome challenges; 2) Laborious dealing with barriers; 3) Acceptance of cultural differences; 4) Complete concentration of personal energy; 5) Taking a powerful step towards tomorrow. CONCLUSION: Results of this study reveal the significance of nurses' experiences in caring for foreign patients for the first time in Korea. The following are suggested: First, facilitation and training is necessary for language proficiency, communication skills and ability to understand cultural traits of foreign patients. Second, manuals and international guidelines for caring for foreign patients should be systematically developed to improve quality of healthcare services.
Employment* ; Humans ; Korea ; Quality of Health Care

Detailed information on additional drug resistance patterns of multidrug-resistant tuberculosis (MDR-TB) is essential to build an effective treatment regimen; however, such data are scarce in Korea. We retrospectively analyzed the results of phenotypic drug susceptibility testing (DST) of culture confirmed-TB patients from January 2010 to December 2014 in 7 university hospitals in Korea. MDR-TB was identified among 6.8% (n = 378) of 5,599 isolates. A total of 57.1% (n = 216) of the MDR-TB patients had never been treated for TB. Strains from MDR-TB patients showed additional resistance to pyrazinamide (PZA) (35.7%), any second-line injectable drug (19.3%), and any fluoroquinolone (26.2%). Extensively drug resistant TB comprised 12.4% (n = 47) of the MDR-TB patients. Of 378 MDR-TB patients, 50.3% (n = 190) were eligible for the shorter MDR-TB regimen, and 50.0% (n = 189) were fully susceptible to the 5 drugs comprising the standard conventional regimen (PZA, kanamycin, ofloxoacin, prothionamide, and cycloserine). In conclusion, the proportion of new patients and the levels of additional drug resistance were high in MDR-TB patients. Considering the high levels of drug resistance, the shorter MDR-TB treatment regimen may not be feasible; instead, an individually tailored regimen based on the results of molecular and phenotypic DST may be more appropriate in MDR-TB patients in Korea.

BACKGROUND: Biodegradable polymers have increasingly been recognized for various biological applications in recent years. Here we examined the immunostimulatory activities of the novel poly(aspartic acid) conjugated with L-lysine (PLA). METHODS: PLA was synthesized by conjugating L-lysine to aspartic acid polymer. PLA-nanoliposomes (PLA-NLs) were prepared from PLA using a microfluidizer. The immunostimulatory activities of PLA-NLs were examined in mouse bone marrow-derived dendritic cells (BM-DCs). RESULTS: PLA-NLs increased the number of BM-DCs when added to cultures of GM-CSF-induced DC generation on day 4 after the initiation of cultures. Examination of the phenotypic properties showed that BM-DCs generated in the presence of PLA-NLs are more mature in terms of the expression of MHC class II molecules and major co-stimulatory molecules than BM-DCs generated in the absence of PLA-NLs. In addition, the BM-DCs exhibited enhanced capability to produce cytokines, such as IL-6, IL-12, TNF-alpha and IL-1beta. Allogeneic mixed lymphocyte reactions also confirmed that the BMDCs were more stimulatory on allogeneic T cells. PLA- NL also induced further growth of immature BM-DCs that were harvested on day 8. CONCLUSION: These results show that PLA-NLs induce the generation and functional activities of BM-DCs, and suggest that PLA-NLs could be immunostimulating agents that target DCs.
Animals ; Aspartic Acid ; Cytokines ; Dendritic Cells ; Immunomodulation ; Interleukin-12 ; Interleukin-6 ; Lymphocyte Culture Test, Mixed ; Lysine ; Mice ; Polymers ; T-Lymphocytes ; Tumor Necrosis Factor-alpha

BACKGROUND: Biodegradable polymers have increasingly been recognized for various biological applications in recent years. Here we examined the immunostimulatory activities of the novel poly(aspartic acid) conjugated with L-lysine (PLA). METHODS: PLA was synthesized by conjugating L-lysine to aspartic acid polymer. PLA-nanoliposomes (PLA-NLs) were prepared from PLA using a microfluidizer. The immunostimulatory activities of PLA-NLs were examined in mouse bone marrow-derived dendritic cells (BM-DCs). RESULTS: PLA-NLs increased the number of BM-DCs when added to cultures of GM-CSF-induced DC generation on day 4 after the initiation of cultures. Examination of the phenotypic properties showed that BM-DCs generated in the presence of PLA-NLs are more mature in terms of the expression of MHC class II molecules and major co-stimulatory molecules than BM-DCs generated in the absence of PLA-NLs. In addition, the BM-DCs exhibited enhanced capability to produce cytokines, such as IL-6, IL-12, TNF-alpha and IL-1beta. Allogeneic mixed lymphocyte reactions also confirmed that the BMDCs were more stimulatory on allogeneic T cells. PLA- NL also induced further growth of immature BM-DCs that were harvested on day 8. CONCLUSION: These results show that PLA-NLs induce the generation and functional activities of BM-DCs, and suggest that PLA-NLs could be immunostimulating agents that target DCs.
Animals ; Aspartic Acid ; Cytokines ; Dendritic Cells ; Immunomodulation ; Interleukin-12 ; Interleukin-6 ; Lymphocyte Culture Test, Mixed ; Lysine ; Mice ; Polymers ; T-Lymphocytes ; Tumor Necrosis Factor-alpha

BACKGROUND/AIMS: Incidentally detected focal 18F-fluorodeoxyglucose (FDG) uptake was compared with colonoscopy. We investigated the characteristics of colon adenomas which were revealed on PET/CT. Then we identified whether additional colonoscopy was necessary in patients with lesions which were revealed on PET/CT but had no matched lesions on colonoscopy. METHODS: We retrospectively reviewed 95 patients who underwent colonoscopy within a 6 month interval after they had focal FDG uptake from January 2010 to May 2012 at National Police Hospital in Korea. Also, we analyzed 30 patients who underwent additional colonoscopy within 2 years after they had no matched lesions on primary colonoscopy. RESULTS: PET/CT depicted 54.6% (41/75) of adenomas and adenocarcinomas. The PET visibility of colon adenoma was significantly associated with degree of dysplasia (p=0.027), histologic type (p=0.040), and the size (p=0.038). The positivity rate was increased with higher degree of dysplasia (low-grade dysplasia, 47%; high-grade dysplasia, 78%; adenocarcinoma, 100%) and villous patterns of histologic type (tubular, 46.8%; tubulovillous, 87.5%; villous, 100%). Patients with adenomas larger than 10 mm (87.5%) had higher detection rate compared to those with adenomas smaller than 10 mm (49.0%). Among the 30 patients who underwent additional colonoscopy, only one patient had a 6 mm sized tubular adenoma (low-grade dysplasia). CONCLUSIONS: Incidental focal colonic uptake may indicate advanced adenoma or adenocarcinoma. Thus, it justifies performing colonoscopy for identifying the presence of colon neoplasms. However, in case of unmatched lesions between PET/CT and colonoscopy, there was little evidence that additional colonoscopy would yield benefits.
Adenocarcinoma/pathology/radiography/radionuclide imaging ; Adenoma/pathology/radiography/radionuclide imaging ; Adult ; Aged ; Colonic Neoplasms/pathology/*radiography/*radionuclide imaging ; Colonic Polyps/pathology ; Colonoscopy ; Female ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Male ; Middle Aged ; Multimodal Imaging ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Retrospective Studies ; Tomography, X-Ray Computed

Cryptococcus neoformans is a fungus that causes opportunistic infections in immunocompromised hosts. Skin lesions are found in 10-20% of systemic cryptococcal infections, usually secondary to cryptococcemia, while primary cutaneous cryptococcosis with cryptococcemia is very rare. We report a case of rapidly spreading cryptococcal cellulitis in a 64-year-old male on maintenance hemodialysis taking steroids for encapsulated peritoneal sclerosis. Bluish bullous cellulitis developed on the left forearm and spread rapidly to the other forearm. We identified C. neoformans in the blood and skin lesions. We treated him successfully with liposomal amphotericin B and fluconazole for 15 months. We also review the literature.
Amphotericin B ; Cellulitis* ; Cryptococcosis ; Cryptococcus neoformans* ; Fluconazole ; Forearm ; Fungi ; Humans ; Immunocompromised Host ; Male ; Middle Aged ; Opportunistic Infections ; Peritoneal Fibrosis ; Renal Dialysis* ; Skin ; Steroids

Rifampin is commonly used as a first-line anti-tuberculosis drug, but it can induce a serum sickness-like reaction or anaphylaxis. However, it is possible for 1 drug antigen to induce 2 or more simultaneous immunologic reactions. Here, we report a case of a serum-sickness-like reaction and anaphylaxis induced concurrently by rifampin. A 25-year-old male presented with high fever and a maculopapular rash with vesicles on the hands, which developed 2 weeks following regular administration of anti-tuberculosis drugs for tuberculous meningitis, including rifampin. Elevated liver enzymes, peripheral neuropathy, and decreased serum C3 and C4 levels were found. Interestingly, these symptoms were accompanied by severe hypotension. A serum-sickness-like reaction was considered after excluding other potential causes for the fever. A drug provocation test showed that the fever developed after oral administration of rifampin, suggesting that rifampin was the cause of the allergic reaction. However, hypotension, epigastric discomfort, and diarrhea also accompanied these symptoms, indicating that IgE-mediated type I hypersensitivity could be part of the serum sickness-like reaction. An intradermal skin test clearly showed an immediate positive reaction to rifampin. This case was diagnosed as concurrent serum-sickness-like reaction and anaphylaxis induced by rifampin. One drug may therefore induce combined allergic reactions via 2 or more simultaneous hypersensitivity responses.
Administration, Oral ; Adult ; Anaphylaxis* ; Diarrhea ; Exanthema ; Fever ; Hand ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Hypotension ; Liver ; Male ; Peripheral Nervous System Diseases ; Rifampin* ; Skin Tests ; Tuberculosis, Meningeal

Azathioprine is a conventional immunosuppressant in renal transplantation but long-term administration may lead to hematologic complications. We here report a cauda equina syndrome caused by spontaneous epidural hematoma in a renal transplant recipient who had undergone long-term azathioprine treatment. A 34 year-old male was admitted to our hospital with complaints of numbness of the lower extremities and back pain. He had received renal transplantation 14 years ago and had been on sole therapy with azathioprine for 11 years. Three months before admission, the patient developed pancytopenia, and a subsequent bone marrow biopsy revealed hypocellularity. Azathioprine was replaced by tacrolimus and steroids thereafter. After a three months discontinuation of azathioprine, an epidural hematoma developed and resulted in cauda equina syndrome. Regular follow-up of complete blood count and change of immunosuppressants with less bone marrow toxicity should be considered in patients receiving azathioprine for long-term period.
Adult ; Azathioprine* ; Back Pain ; Biopsy ; Blood Cell Count ; Bone Marrow ; Cauda Equina* ; Follow-Up Studies ; Hematoma ; Humans ; Hypesthesia ; Immunosuppressive Agents ; Kidney Transplantation ; Lower Extremity ; Male ; Pancytopenia ; Polyradiculopathy* ; Steroids ; Tacrolimus ; Transplantation

BACKGROUND: Endothelial dysfunction has been documented in patients with type 2 diabetes especially when combined with hypertension. We prospectively investigated the effects of pioglitazone in improving endothelial function in hypertensive type 2 diabetic patients during the 6-month follow-up. METHODS: Hypertensive type 2 diabetic patients were randomly assigned to pioglitazone (n = 25) or placebo (n = 25). Primary endpoint was to compare changes in brachial artery flow-mediated dilation (baFMD) between the 2 groups during the 6-month follow-up. Secondary endpoints were to compare changes in the circulating levels of microRNA-17, -21, 92a, -126, and -145 which have been known as indicators of endothelial cell migration and atherosclerosis progression during the 6-month follow-up. Inflammatory markers such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), high-sensitive C-reactive protein, adiponectin, soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1) were compared during the follow-up. RESULTS: The prevalences of risk factors such as hyperlipidemia, smoking, stroke, and family history of coronary artery disease did not show significant differences between the 2 groups. Increases in baFMD (0.33 +/- 0.34 mm vs. 0.02 +/- 0.25 mm, p < 0.05, respectively) and in the level of circulating microRNA-21 (0.23 +/- 0.05 vs. -0.06 +/- 0.04, p < 0.05, respectively) were significantly greater in the pioglitazone group when compared to the placebo group during the 6-month follow-up. No significant differences in the prevalences of new onset heart failure, fracture, and bladder cancer were noted during the follow-up between the 2 groups. Decreases in the levels of inflammatory marker such as IL-6 (-2.54 +/- 2.32 pg/mL vs. -1.34 +/- 2.12 pg/mL, p < 0.05, respectively), TNF-alpha (-1.54 +/- 1.51 pg/mL vs. 0.14 +/- 1.12 pg/mL, p < 0.05, respectively), sICAM-1 (-39 +/- 52 ng/mL vs. 6 +/- 72 ng/mL, p < 0.05, respectively), and sVCAM-1 (-154 +/- 198 ng/mL vs. -11 +/- 356 ng/mL, p < 0.05, respectively) were significantly greater in the pioglitazone group compared to the placebo group during the follow-up. CONCLUSIONS: In hypertensive type 2 diabetic patients, pioglitazone may increase baFMD and circulatory microRNA-21 and decrease inflammatory cytokines including IL-6, TNF-alpha, sICAM-1, and sVCAM-1.
Adiponectin ; Atherosclerosis ; Brachial Artery* ; C-Reactive Protein ; Coronary Artery Disease ; Cytokines ; Diabetes Mellitus ; Endothelial Cells ; Follow-Up Studies ; Heart Failure ; Humans ; Hyperlipidemias ; Hypertension ; Intercellular Adhesion Molecule-1 ; Interleukin-6 ; MicroRNAs ; Prevalence ; Prospective Studies ; Risk Factors ; Smoke ; Smoking ; Stroke ; Tumor Necrosis Factor-alpha ; Urinary Bladder Neoplasms ; Vascular Cell Adhesion Molecule-1