Conventional abdominoplasty includes the removal of an ellipse-shaped section of abdominal tissue between the umbilicus and mons pubis. However, this method can result in tension of the undermined flap, especially in the midline. To address this problem, we present reverse lip design as a modified method that also has aesthetic advantages. The reverse lip design entails a longer lower flap edge while preserving the triangular tissue in the vascularly stable pubis area. These markings create an image of a reverse lip shape with a cleft at the bottom of the lower markings. After typical lipoabdominoplasty is performed, redundant waist tissues can easily be pulled inward and downward. The reverse lip design abdominoplasty demonstrated no complications and required no further revisions after the procedure. Patients were generally satisfied with the aesthetic improvements in their body shape. They were also able to return to their routine activities approximately 1 week after the operation while wearing a supporting undergarment. This modified abdominoplasty using the reverse lip design reduces low midline tension of the undermined abdominal flap while enhancing body aesthetics with a slimmer waistline, leading to higher patient satisfaction.

PURPOSE: This study aimed to evaluate the outcomes of a community-based palliative care project conducted in Busan city, Korea, from 2013 to 2015. METHODS: We selected four outcome indices based on the project's outcomes derived from a logic model and used a longitudinal and cross-sectional comparative design approach depending on the outcome index. RESULTS: The utilization rate of palliative care increased from 9.2% in 2012 to 41.9% in 2015. Regarding symptom changes in 65 patients receiving palliative care at 3 and 6 months (mean age = 72 years, standard deviation = 9.64, 55.4% women), pain, anxiety, and depression had improved. Quality of life was higher among palliative care patients compared with patients who did not receive palliative care (t = 2.09, p = .039). Regarding recognition of palliative care, civil servants at public health centers who participated in the pilot project (2013–2014) scored higher than those at public health centers who began participation in 2015 (t = 2.67, p = .008). CONCLUSION: This is the first study in Korea that systematically evaluated community-based palliative care. The Busan Community-based Palliative Care Project improved the quality of life of palliative care patients by providing services at an appropriate level and by raising the recognition of palliative care in the community. To increase the utilization ratio of palliative care and the quality of service, strategies should be developed to supplement medical support systems.
Anxiety ; Busan* ; Depression ; Humans ; Korea* ; Logic ; Palliative Care* ; Pilot Projects ; Public Health ; Quality of Life

PURPOSE: A feasible palliative care model for advance cancer patients is needed in Korea with its rapidly aging population and corresponding increase in cancer prevalence. This study describes the process involved in the development of a community-based palliative care (CBPC) model implemented originally in a Busan pilot project. MATERIALS AND METHODS: The model development included steps I and II of the pilot project, identification of the service types, a survey exploring the community demand for palliative care, construction of an operational infrastructure, and the establishment of a service delivery system. Public health centers (including Busan regional cancer centers, palliative care centers, and social welfare centers) served as the regional hubs in the development of a palliative care model. RESULTS: The palliative care project included the provision of palliative care, establishment of a support system for the operations, improvement of personnel capacity, development of an educational and promotional program, and the establishment of an assessment system to improve quality. The operational infrastructure included a service management team, provision teams, and a support team. The Busan Metropolitan City CBPC model was based on the principles of palliative care as well as the characteristics of public health centers that implemented the community health projects. CONCLUSION: The potential use of the Busan CBPC model in Korea should be explored further through service evaluations.
Aging ; Busan* ; Chronic Disease ; Humans ; Korea* ; Palliative Care* ; Pilot Projects ; Prevalence ; Public Health* ; Social Welfare

BACKGROUND: Limited data on the incidence and clinical characteristics of adult pertussis infections are available in Korea. METHODS: Thirty-one hospitals and the Korean Centers for Disease Control and Prevention collaborated to investigate the incidence and clinical characteristics of pertussis infections among adults with a bothersome cough in non-outbreak, ordinary outpatient settings. Nasopharyngeal aspirates or nasopharyngeal swabs were collected for polymerase chain reaction (PCR) and culture tests. RESULTS: The study enrolled 934 patients between September 2009 and April 2011. Five patients were diagnosed as confirmed cases, satisfying both clinical and laboratory criteria (five positive PCR and one concurrent positive culture). Among 607 patients with cough duration of at least 2 weeks, 504 satisfied the clinical criteria of the US Centers for Disease Control and Prevention (i.e., probable case). The clinical pertussis cases (i.e., both probable and confirmed cases) had a wide age distribution (45.7+/-15.5 years) and cough duration (median, 30 days; interquartile range, 18.0~50.0 days). In addition, sputum, rhinorrhea, and myalgia were less common and dyspnea was more common in the clinical cases, compared to the others (p=0.037, p=0.006, p=0.005, and p=0.030, respectively). CONCLUSION: The positive rate of pertussis infection may be low in non-outbreak, ordinary clinical settings if a PCR-based method is used. However, further prospective, well-designed, multicenter studies are needed.
Adult ; Age Distribution ; Centers for Disease Control and Prevention (U.S.) ; Cough ; Dyspnea ; Humans ; Incidence ; Outpatients ; Polymerase Chain Reaction ; Sputum ; Whooping Cough

Porphyromonas gingivalis, one of the major periodontal pathogens, is implicated in the initiation and progression of periodontal disease. The initial stages of periodontal inflammation are accompanied by vascular hyperpermeability. In our present study, we report that the P. gingivalis lipopolysaccharide (LPS) increases the mRNA expression of interleukin-8 (IL-8), a major inducer of vascular permeability, in vascular endothelial cells. P. gingivalis LPS also stimulated the induction of IL-8 secretion in endothelial cells. The P. gingivalis LPS-induced expression of IL-8 was primarily modulated by nuclear factor-kappaB (NF-kappaB). P. gingivalis LPS significantly enhanced the vascular permeability both in vitro and in vivo, and a blockade of the IL-8 receptor decreased the P. gingivalis LPS-induced vascular permeability. Taken together, these results suggest that P. gingivalis LPS increases vascular permeability through the NF-kappaB-dependent production of IL-8 in vascular endothelial cells.
Capillary Permeability ; Endothelial Cells ; Inflammation ; Interleukin-8 ; Periodontal Diseases ; Porphyromonas ; Porphyromonas gingivalis ; RNA, Messenger

BACKGROUND: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality throughout the world in all age groups. Viral causes of CAP are less well characterized than bacterial causes. We analyzed the characteristics of hospitalized patients with CAP who had a viral pathogen detected by multiplex polymerase chain reaction (PCR). METHODS: Multiplex real-time PCR was performed for respiratory viruses in samples collected from 520 adults who developed CAP at Chungnam National University Hospital. Clinical, laboratory, and radiological features at presentation as well as other epidemiological data were analyzed. RESULTS: Of 520 patients with CAP, a viral pathogen was detected in 60 (11.5%), and influenza A was the most common. The virus detection rate in patients with CAP was highest in November. Two or more pathogens were detected in 13 (21.7%) patients. Seven patients had severe disease and were administered in the intensive care unit. Most patients (49/60, 81.7%) had comorbidities. However, nine (15%) patients had no comorbidities, and their age was <60 years. The ground glass opacity pattern was the most common radiological feature. Seven (11.7%) patients died from CAP. CONCLUSION: Viral pathogens are commonly detected in patients with CAP, and a respiratory virus may be associated with the severity and outcome of pneumonia. Careful attention should be paid to the viral etiology in adult patients with CAP.
Adult ; Comorbidity ; Glass ; Humans ; Influenza, Human ; Intensive Care Units ; Multiplex Polymerase Chain Reaction ; Pneumonia ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; Viruses

BACKGROUND AND OBJECTIVES: Although the Tei index is a useful predictor of global ventricular function, it has not been investigated at the level of regional myocardial function. We therefore investigated the segmental tissue Doppler image derived-Tei index (TDI-Tei index) in patients with regional wall motion abnormalities. SUBJECTS AND METHODS: We prospectively studied 17 patients (mean age 62+/-9 years, 5 women) with left ventricular (LV) regional wall motion abnormalities. The Tei index, defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET), was measured in the basal and mid segments of the LV walls from standard apical views (4-, 2-, and 5-chamber views). We also obtained TDI velocity data in each segment. LV wall motion was classified as normal, hypokinetic, or akinetic, based on visual analysis. The TDI-Tei index, peak systolic myocardial velocity (Sm), early diastolic myocardial velocity (Em), and late diastolic myocardial velocity (Am) were analyzed in a total of 203 segments. RESULTS: Mean LV ejection fraction was 41.8+/-8.5%. TDI-Tei indices of dysfunctional segments (akinesis or hypokinesis, n=63) were significantly higher than those of normal segments (n=140) (0.714+/-0.169 vs. 0.669+/-0.135, p=0.041, respectively). Average values of TDI-Tei index, Sm, Em, and Am were 0.742+/-0.201, 4.206+/-1.336, 5.258+/-1.867, and 5.578+/-2.354 in akinetic segments; 0.677+/-0.101, 4.908+/-1.615, 5.369+/-2.121, and 5.542+/-2.492 in hypokinetic segments; and 0.669+/-0.135, 5.409+/-1.519, 6.108+/-2.356, and 6.719+/-2.466 in normal segments, respectively. A significant negative correlation was apparent between the TDI-Tei index and Sm (r=-0.302, p<0.001). CONCLUSION: These data suggest that the value of the segmental TDI-Tei index differs significantly according to regional function grade.
Contracts ; Humans ; Myocardial Contraction ; Prospective Studies ; Relaxation ; Ventricular Function

PURPOSE: Recently the incidence of severe hyponatremia is increasing in old patients but there is no report about clinical findings of old patients with hyponatremia. We evaluated the cause and clinical manifestations of severe hyponatremia in old patients who had been admitted via emergency room. METHODS: We retrospectively reviewed clinical records of the hyponatremic patients who had been admitted from 2000 to 2007. We enrolled 53 patients (Age >60 years, Na <125 mEq/L) without severe liver cirrhosis, heart failure or chronic kidney disease. We analyzed data to evaluate the differences of clinical manifestations according to the presence of symptoms, taking diuretics, urine sodium concentrations and the degree of hyponatremia. RESULTS: Mean serum sodium concentration was 111.4+/-6.9 mEq/L and urine sodium concentration was 68.7+/-43.8 mEq/L. There was no difference in serum sodium concentration according to age. Twenty-nine (54.7%) patients had nausea and vomiting and 19 patients (35.8%) had neurologic symptoms. Patients with neurologic symptoms showed lower serum and urine sodium concentration than patients without neurologic symptoms. The main causes of severe hyponatremia were poor oral intake (79.2%), diuretics use (37.7%) and recent operation (15.1%). The mean sodium concentration of the fluid administered to achieve 125 mEq/L of serum sodium level was 336.5+/-160.6 mEq/L. CONCLUSION: The urinary sodium loss, e.g., diuretics abuse, may be the main cause of severe hyponatremia in elderly patients over 60 years. In elderly patients, diuretics should be carefully administered with frequent electrolyte monitoring.
Aged ; Diuretics ; Emergencies ; Heart Failure ; Humans ; Hyponatremia ; Incidence ; Liver Cirrhosis ; Nausea ; Neurologic Manifestations ; Renal Insufficiency, Chronic ; Retrospective Studies ; Sodium ; Vomiting

BACKGROUND: To evaluate the usefulness and compliance of a hospital-based tabletop exercise in setting of pandemic influenza in hospitals. MATERIALS AND METHODS: Tabletop exercise was held in Pusan National University Hospital and forty two hospital employees were invited to participate in the exercise. The scenario for hospital-based tabletop exercise was designed. It consisted of three modules, which simulated the influx and outbreak of H5N1 influenza that was epidemic in Southeast Asia. Pre-, post-exercise surveys were completed by anonymous questions. RESULTS: Thirty-seven (88%) of 42 invited participants attended exercise. All members of the administration group and the ancillary services group participated. But, only 77% members of the clinical services group participated. In pre-exercise survey, priorities of eight goals regarding skills and knowledge during exercise were inquired., The highest priorities pointed out by the respondents were "Increase the knowledge of pandemic influenza" (22%), "Development of strategies for optimal communication among employees within specific department" (19%) and "Development of strategies for improved coordination between facilities within the health system" (19%). Twenty-one (57%) of participants completed the post-exercise surveys. At post-exercise surveys, 81% of the participants stated that the tabletop exercise was extremely or very useful, 86% of the participants also stated that it increased their knowledge of pandemic influenza. CONCLUSION: Tabletop exercise is an effective modality for increasing pandemic influenza preparedness in hospitals, and this method is useful for guiding preparedness activities within the hospital environment. Further studies to determine the appropriate method of discussion, questionnaire, duration of exercise and injection are needed.
Anonyms and Pseudonyms ; Asia, Southeastern ; Compliance ; Influenza, Human ; Pandemics ; Surveys and Questionnaires

BACKGROUND: To evaluate the usefulness and compliance of a hospital-based tabletop exercise in setting of pandemic influenza in hospitals. MATERIALS AND METHODS: Tabletop exercise was held in Pusan National University Hospital and forty two hospital employees were invited to participate in the exercise. The scenario for hospital-based tabletop exercise was designed. It consisted of three modules, which simulated the influx and outbreak of H5N1 influenza that was epidemic in Southeast Asia. Pre-, post-exercise surveys were completed by anonymous questions. RESULTS: Thirty-seven (88%) of 42 invited participants attended exercise. All members of the administration group and the ancillary services group participated. But, only 77% members of the clinical services group participated. In pre-exercise survey, priorities of eight goals regarding skills and knowledge during exercise were inquired., The highest priorities pointed out by the respondents were "Increase the knowledge of pandemic influenza" (22%), "Development of strategies for optimal communication among employees within specific department" (19%) and "Development of strategies for improved coordination between facilities within the health system" (19%). Twenty-one (57%) of participants completed the post-exercise surveys. At post-exercise surveys, 81% of the participants stated that the tabletop exercise was extremely or very useful, 86% of the participants also stated that it increased their knowledge of pandemic influenza. CONCLUSION: Tabletop exercise is an effective modality for increasing pandemic influenza preparedness in hospitals, and this method is useful for guiding preparedness activities within the hospital environment. Further studies to determine the appropriate method of discussion, questionnaire, duration of exercise and injection are needed.
Anonyms and Pseudonyms ; Asia, Southeastern ; Compliance ; Influenza, Human ; Pandemics ; Surveys and Questionnaires