BACKGROUND: Bacteremia is a life-threatening infection, and prognosis is highly dependent on early recognition and treatment with appropriate antimicrobial agents. We investigated the diagnostic performance of serum procalcitonin (PCT) for differentiation between contaminants and true pathogens in blood cultures. METHODS: Serum PCT, C-reactive protein (CRP) and blood culture were performed for 473 patients between February 2008 and October 2008. We retrospectively reviewed the patients' clinical characteristics and laboratory results based on medical records. RESULTS: The mean concentration of PCT was significantly different between the two negative and positive blood culture groups (6.45 ng/mL vs 28.77 ng/mL, P<0.001). Procalcitonin levels were found to be markedly higher in those with Gram-negative bacilli (mean+/-SD; 59.58+/-67.00 ng/mL) bacteremia than in those with Gram-positive cocci (mean+/-SD; 17.75+/-42.88 ng/mL) bacteremia (P<0.001). The areas under the receiver operating characteristic curves (95% confidence interval) for PCT and CRP were 0.880 (0.820~0.940) and 0.637 (0.538~0.736), respectively. The use of a PCT level of 2 ng/mL as a cutoff value yielded an 83.6% positive predictive value and a 77.4% negative predictive value for the detection of bacteremia pathogens. CONCLUSION: Serum PCT is a helpful diagnostic marker for rapidly and accurately distinguishing between contaminants and pathogens in blood cultures.
Anti-Infective Agents ; Bacteremia ; C-Reactive Protein ; Calcitonin ; Gram-Positive Cocci ; Humans ; Prognosis ; Protein Precursors ; Retrospective Studies ; ROC Curve

To evaluate the prevalence of cumulative trauma disorders in relation to ergonomic evaluation of their work, 260 female directory assistance operators employed in three branch facilities of the nation-wide telecommunication company. Ergonomic evaluation of the work status was done by two industrial hygienists through inspection. Workers were surveyed with standardized self-administered questionnaire and examined by family physicians and an orthopaedician for cumulative trauma disorders. Laboratory examination of serum aspartate aminotransferase(AST), creatinine phosphokinase(CPK), aldolase and rheumatoid factor was done and X-ray of cervical spine and both shoulders was taken from all subjects and nerve conduction velocity test was done on 57 subjects with suspected nerve entrapment cases. Cumulative trauma disorders were categorized into 3 category according to work-relatedness of the disorders. On ergonomic evaluation of the working posture and work environment, improvement of work posture revealed inappropriate postures and devices. Mean age of the subjects were 39 years old and more than 80% graduated high school or above. Ninety-eight percent of the workers employed in the company for more than 15 years and 74.6% of the workers worked at the VDT job for more than 4 years. Mean daily work hours was 8.0 hours per day and mean break hours was 90.5 minutes per day with mean extra work hours of 10.7 hours per month. Mean daily calls were 1128.6 calls in maximum and 864.8 calls in minimum. On laboratory examination, 13 (5.0%) workers had abnormal AST, 53(20.4%) had abnormal CPK, and 1 (0.4%) had abnormal aldolase level. On x-ray examination of cervical spine, 111 (42.7%) had loss of or reversed normal cervical lordosis, 10(3.8%) had narrowing of intervertebral space. Nerve conduction velocity test was abnormal in 11 (19.2%) among 57 workers. Among disorders categorized as work-related, 131 (50.4%) were diagnosed to have fatigue myalgia of levator scapulae, 108 (41.5%) had cervical strain or sprain, 47 (18.1%) had fatigue arthralgia of phalangeal joints, and 47 (18.1%) had probable carpal tunnel syndrome, in 10 (3.8%) of those diagnosis was confirmed electrophysiologically. Age, seniority, work duration at present job, workload nor location of facilities were associated with the prevalence of symptoms nor specific diagnoses on simple statistical analysis and multiple logistic regression, which deems to be due to highly selected and homogeneous characteristics of the study subjects. Above results shows that cumulative trauma disorders are very prevalent among directory assistance operators and elaborate effort is needed to reduce the cumulative trauma disorders among the operators.
Adult ; Animals ; Arthralgia ; Aspartic Acid ; Carpal Tunnel Syndrome ; Creatinine ; Cumulative Trauma Disorders* ; Diagnosis ; Fatigue ; Female ; Fructose-Bisphosphate Aldolase ; Humans ; Joints ; Logistic Models ; Lordosis ; Myalgia ; Nerve Compression Syndromes ; Neural Conduction ; Physicians, Family ; Posture ; Prevalence ; Questionnaires ; Rheumatoid Factor ; Shoulder ; Spine ; Sprains and Strains ; Superficial Back Muscles ; Telecommunications ; Telephone*

Authors report a first Korean case of polyneuropathy in an acrylamide producing factory together with an environmental and epidemiologic survey for the ten workers of the same workplace and 46 workers in the production and manufacturing acrylamide in Ulsan, Korea. The case is 30 years old man who worked in the prcduction of the acrylamide for two years. In August, 1997, he had a weakness of the lower extremity with loss of body weight of 15 Kg which progressed to paresthesia of the limbs, the loss of vibration sense, difficulty in walking, speech disturbance, dysuria, constipation, difficulty in erection and swallowing difficulty. Neurologic examination showed a complete loss of vibration and position sense, and loss of deep tendon reflex in all the limbs. There was a contact dermatitis-like skin lesion on the feet. Electrodiagnostic test showed a generalized polyneuropathy of moderate degree involving motor and sensory component of peripheral and cranial nerves. After 8 months' cessation from exposure and supportive care, his symptoms were completely resolved, but abnormality in electrodiagnostic test and vibrotactile perception threshold still persisted, although much improved than before. There were 11 workers in the same workplace of the case, producing acrylamide by microorganism as a catalyst. Environmental monitoring of the workplace revealed air-borne concentration of the acrylamide to be from 0.05 to 0.23 mg/m(3) by personal sampling and from 7.65 to 11.65 mg/m(3) by area sampling during filter exchanging process, which far exceeds TLV-TWA of 0.03 mg/m(3). However acrylamide was not detected from the plasma of the workers. Symptom questionnaire showed a markedly higher complain of neurologic symptoms, compared to the workers of the other acrylamide producing companies. Electrodiagnostic test showed a several workers are in the lower normal range without definite abnormality. Vibrotactile perception threshold by Vibratron II showed a significantly increased threshold in the workers of the same workplace compared to the other acrylamide workers and significantly decreased test score of color vision compared to normal controls. After improvement of the production process and strict wearing of the protective device, most workers reported the improvement of clinical symptoms, but vibrotactile perception threshold was not improved. These result suggests the need for the effective environmental monitoring together with a periodic biological monitoring. Development of effective screening test is urgently needed to control and assess the skin absorption of acrylamide.
Acrylamide* ; Adult ; Body Weight ; Color Vision ; Constipation ; Cranial Nerves ; Deglutition ; Dysuria ; Environmental Monitoring ; Extremities ; Foot ; Humans ; Korea ; Lower Extremity ; Mass Screening ; Neurologic Examination ; Neurologic Manifestations ; Occupational Exposure* ; Paresthesia ; Plasma ; Polyneuropathies* ; Proprioception ; Protective Devices ; Questionnaires ; Reference Values ; Reflex, Stretch ; Skin ; Skin Absorption ; Threshold Limit Values ; Ulsan ; Vibration ; Walking

RUNX1, a member of the runt domain gene family of transcription factors, encodes a heterodimeric transcription factor and regulates the expression of various genes related to hematopoiesis and myeloid differentiation. RUNX1 has been one of the target genes for research into various autoimmune diseases due to its properties as a transcription factor and functional distribution for chromosomal translocation. In an effort to identify additional gene polymorphisms in which variants have been implicated in asthma, we investigated the genetic polymorphisms in RUNX1 to evaluate it as a potential candidate gene for a host genetic study of asthma and IgE production. We identified 19 sequence variants by direct DNA sequencing in 24 individuals of which four common variants were selected for genotyping in our asthma cohort (1,055 asthmatic patients, 384 normal controls). Using logistic regression analysis for association with the risk of asthma, while controlling for age, gender, and smoking status as covariates, no significant associations with the risk of asthma were detected. However, two polymorphisms in the promoter region (-2084G>C and -1282G>A) showed a marginal association with total IgE levels (0.03 and 0.03 in recessive models, respectively). Our findings suggest that polymorphisms in RUNX1 might be one of the genetic factors for the regulation of IgE production.
Sequence Analysis, DNA ; Risk Factors ; Polymorphism, Single Nucleotide ; *Polymorphism, Genetic ; Middle Aged ; Male ; Korea ; Immunoglobulin E/*blood ; Humans ; Female ; Data Collection ; Core Binding Factor Alpha 2 Subunit/*genetics ; Cohort Studies ; Child, Preschool ; Child ; Asthma/epidemiology/genetics ; Aged, 80 and over ; Aged ; Adult ; Adolescent

BACKGROUND: Korean Nosocomial Infections Surveillance System (KONIS) operating since July 2006 is the first nationwide monitoring system for nosocomial infections in the in the intensive care unit (lCU) with a standard protocol and web-based prompt response network in Korea. This report describes the characteristics of the KONIS hospitals compared with those of all Korean hospitals with 400 beds and over. METHODS: A survey was conducted for the 44 hospitals participating in KONIS 2006, and the data were rechecked by the KONIS hospitals through KONIS web-network. The survey form included questions about the size of the hospital, infection control personnel, nursing personnel, and the status of microbiologic laboratory. RESULTS: Compared to all Korean hospitals with 400 beds and over, the KONIS hospitals were larger in term of average number of beds (857 vs 654); the number of hospitals with 700 beds and over was over-represented in Seoul (P=0.01) and under-represented in the central/south area (P<0.001) The majority of the KONIS hospitals were major teaching university-affiliated (88,6%) and private (72.7%), but in the central/south area, public hospitals comprised up to 60%. The number of infection control professionals (ICP) averaged 1.6, hospital beds per ICP 531, and infectious disease physicians 1.3. Medical and medical combined ICUs were the major component (67,1%) of the KONIS ICUs, The lCU bed per nurse was 0.63. CONCLUSION: The KONIS 2006 hospitals were over-represented in the overall indicators in Seoul. Because no objective indicators were available regarding the patient quality, KONIS data must be interpreted in consideration of all indicators.
Communicable Diseases ; Cross Infection* ; Hospitals, Public ; Humans ; Infection Control ; Intensive Care Units ; Korea ; Nursing ; Seoul

Lipoprotein plays a role in the host defense against bacterial infection, and its serum level has been demonstrated to be an important prognosis factor of survival. We have previously demonstrated that LDL directly inactivates the hemolytic activity of Vibrio vulnificus cytolysin (VVC) in vitro. The object of this study was therefore to examine whether the LDL-mediated inactivation of VVC leads to protection against lethal infection of V. vulnificus in vivo, using wild and VVC-deficient V. vulnificus strains. Unexpectedly, we found that LDL protects mouse lethality induced by VVC-deficient as well as wild V. vulnificus strain. We also demonstrated that LDL blocks V. vulnificus LPS-induced lethality in mice. These results suggest that LDL preferentially act on endotoxin rather than exotoxin in the protection against V. vulnificus-induced mice lethality.
Animals ; Disease Models, Animal ; Female ; Humans ; Lipopolysaccharides/*antagonists & inhibitors ; Lipoproteins, LDL/*pharmacology ; Mice ; Mice, Inbred ICR ; Perforin/antagonists & inhibitors/genetics ; Vibrio Infections/prevention & control ; Vibrio vulnificus/*drug effects/genetics/*pathogenicity ; Virulence/drug effects/genetics/physiology

In 2007, the Korean Interstitial Lung Disease Society had collected clinical data of patients who have diagnosed as Lymphangioleiomyomatosis (LAM) since 1990 through nationwide survey, which showed that LAM patients had increased sharply after 2004. The present study was performed to show the clinical features of Korean patients with LAM, and to establish the reason for the recent increase in the diagnosis. All 63 patients were women and the mean age at diagnosis was 36 yr. The most common presenting symptom was dyspnea and 8 patients had tuberous sclerosis complex. The survival rate at 5 yr after diagnosis was 84%. Compared with patients diagnosed after 2004 (n=34), the patients diagnosed before 2004 (n=29) complained with dyspnea more (P=0.016) and had lower FEV1% predicted (P=0.003), and DLco% predicted (P=0.042). The higher proportion of patients diagnosed after 2004 showed the normal chest radiography, and they were detected by routine chest CT screening (P=0.016). This study showed that clinical features of Korean patients with LAM were not different from those reported elsewhere. It is concluded that the reason for the increase of newly diagnosed patients is the result of increase in detection of the early stage LAM by the widespread use of chest CT screening.
Adult ; Aged ; Early Diagnosis ; Female ; Humans ; Lung Neoplasms/*diagnosis/mortality/radiography ; Lymphangioleiomyomatosis/*diagnosis/mortality/radiography ; Middle Aged ; Republic of Korea ; Respiratory Function Tests ; Survival Rate ; Tomography, X-Ray Computed

BACKGROUND: THe Korean Society for Nosocomial Infection Control (KOSNIC) orfanized the Korean Nosocomial Infections Surveillance System (KONIS) to establish a nationwide database of Nosocomial infection (NI) rate in the intensive care units (ICUs) of Korean hospitals. This report is a summary of the data from July through September 2006. METHODS: The KONIS performed a prospective sruveillance for nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 76 ICUs in 44 hospitals. NI rates were calculated as the numbers of infections per 1,000 patient-days or device-days. RESULTS: A total of 846 nosocomial infections were fOlllld during the study period: 407 UTIs (397 cases were urinary catheter-associated), 204 BSIs (182 were central line-associated), and 235 PNEUs (161 were ventilator-associated). The rate of urinary catheter-associated UTIs was 4.61 cases per 1,000 device-days and urinary catheter utilization ratio was 0.83. The rate of central line-associated BSIs was 3.16 and the utilization ratio was 0.55. The rate of ventilator-associated PNEUs was 3.80 and the utilization ratio was 0.41. Although the ventilator utilization ratio was lower in the hospitals with 400-699 beds than in the hospitals with more than 900 beds, the rate of ventilator-associated pneumonia was higher in the smaller hospitals than in the larger ones. The rates of all three device-associated infections were the highest in the neurosurgical ICUs and the rates were the lowest in the surgical ICUs. CONCLUSION: This study may contribute to the development of effective strategies for NI control according to the size of hospital and the type of ICUs.
Cross Infection* ; Intensive Care Units ; Pneumonia ; Pneumonia, Ventilator-Associated ; Prospective Studies ; Urinary Catheters ; Urinary Tract Infections ; Ventilators, Mechanical