Background: Proliferative enteritis caused by Lawsonia intracellularis undermines the economic stability of the swine industry worldwide. The development of cost-effective animal models to study the pathophysiology of the disease will help develop strategies to counter this bacterium. Objectives: This study focused on establishing a model of gastrointestinal (GI) infection of L.intracellularis in C57BL/6 mice to evaluate the disease progression and lesions of proliferative enteropathy (PE) in murine GI tissue. Methods: We assessed the murine mucosal and cell-mediated immune responses generated in response to inoculation with L. intracellularis. Results: The mice developed characteristic lesions of the disease and shed L.intracellularis in the feces following oral inoculation with 5 × 107 bacteria. An increase in L. intracellularis 16s rRNA and groEL copies in the intestine of infected mice indicated intestinal dissemination of the bacteria. The C57BL/6 mice appeared capable of modulating humoral and cell-mediated immune responses to L. intracellularis infection. Notably, the expression of genes for the vitamin B12 receptor and for secreted and membrane-bound mucins were downregulated in L. intracellularis -infected mice. Furthermore, L. intracellularis colonization of the mouse intestine was confirmed by the immunohistochemistry and western blot analyses. Conclusions This is the first study demonstrating the contributions of bacterial chaperonin and host nutrient genes to PE using an immunocompetent mouse model. This mouse infection model may serve as a platform from which to study L. intracellularis infection and develop potential vaccination and therapeutic strategies to treat PE.

Purpose: Ankle fractures are common in the orthopedic field. Lateral malleolar fractures are often treated with lag screws and locking plates. Cortical screws are typically used as lag screws to achieve absolute stability through compression. In osteoporotic bone, however, achieving sufficient compression with cortical screws can be challenging. Cancellous screws may offer better fixation in metaphyseal bone. This study compared the outcomes of using cortical screws as lag screws and cancellous screws as position screws for lateral malleolar fixation. Materials and Methods: This retrospective study included patients who underwent surgery for Weber type B ankle fractures at the authors’ hospital between March 2019 and March 2022. The patients were divided into two groups based on the screw type: cortical lag screws (n=70) and cancellous position screws (n=35). In both groups, a locking plate was applied in the same manner after screw fixation. The outcomes were evaluated using the visual analog scale (VAS), Olerud-Molander score (OMS), foot and ankle outcome score (FAOS), and foot function index (FFI). Complications, such as fixation failure, nonunion, and malunion, were recorded. Results: One hundred and five patients were included. The mean follow-up duration was 16 months (range, 12~28 months). The VAS (1.6±1.9 vs. 1.1±1.3, p=0.305), FFI (10.3±13.4 vs. 10.4±13.5, p=0.970), FAOS (83.0±14.4 vs. 83.5±14.4, p=0.899), and OMS (85.3±18.4 vs.84.7±17.6, p=0.910) scores were similar in the two groups. No complications were reported in either group. Conclusion For the fixation of Weber B fibular fractures, cortical lag screws and cancellous position screws showed comparable clinical outcomes. Cancellous screws with plate fixation may offer a viable alternative in cases with poor bone quality or difficulty applying lag screw techniques.

Purpose: Ankle fractures are common in the orthopedic field. Lateral malleolar fractures are often treated with lag screws and locking plates. Cortical screws are typically used as lag screws to achieve absolute stability through compression. In osteoporotic bone, however, achieving sufficient compression with cortical screws can be challenging. Cancellous screws may offer better fixation in metaphyseal bone. This study compared the outcomes of using cortical screws as lag screws and cancellous screws as position screws for lateral malleolar fixation. Materials and Methods: This retrospective study included patients who underwent surgery for Weber type B ankle fractures at the authors’ hospital between March 2019 and March 2022. The patients were divided into two groups based on the screw type: cortical lag screws (n=70) and cancellous position screws (n=35). In both groups, a locking plate was applied in the same manner after screw fixation. The outcomes were evaluated using the visual analog scale (VAS), Olerud-Molander score (OMS), foot and ankle outcome score (FAOS), and foot function index (FFI). Complications, such as fixation failure, nonunion, and malunion, were recorded. Results: One hundred and five patients were included. The mean follow-up duration was 16 months (range, 12~28 months). The VAS (1.6±1.9 vs. 1.1±1.3, p=0.305), FFI (10.3±13.4 vs. 10.4±13.5, p=0.970), FAOS (83.0±14.4 vs. 83.5±14.4, p=0.899), and OMS (85.3±18.4 vs.84.7±17.6, p=0.910) scores were similar in the two groups. No complications were reported in either group. Conclusion For the fixation of Weber B fibular fractures, cortical lag screws and cancellous position screws showed comparable clinical outcomes. Cancellous screws with plate fixation may offer a viable alternative in cases with poor bone quality or difficulty applying lag screw techniques.

Purpose: Ankle fractures are common in the orthopedic field. Lateral malleolar fractures are often treated with lag screws and locking plates. Cortical screws are typically used as lag screws to achieve absolute stability through compression. In osteoporotic bone, however, achieving sufficient compression with cortical screws can be challenging. Cancellous screws may offer better fixation in metaphyseal bone. This study compared the outcomes of using cortical screws as lag screws and cancellous screws as position screws for lateral malleolar fixation. Materials and Methods: This retrospective study included patients who underwent surgery for Weber type B ankle fractures at the authors’ hospital between March 2019 and March 2022. The patients were divided into two groups based on the screw type: cortical lag screws (n=70) and cancellous position screws (n=35). In both groups, a locking plate was applied in the same manner after screw fixation. The outcomes were evaluated using the visual analog scale (VAS), Olerud-Molander score (OMS), foot and ankle outcome score (FAOS), and foot function index (FFI). Complications, such as fixation failure, nonunion, and malunion, were recorded. Results: One hundred and five patients were included. The mean follow-up duration was 16 months (range, 12~28 months). The VAS (1.6±1.9 vs. 1.1±1.3, p=0.305), FFI (10.3±13.4 vs. 10.4±13.5, p=0.970), FAOS (83.0±14.4 vs. 83.5±14.4, p=0.899), and OMS (85.3±18.4 vs.84.7±17.6, p=0.910) scores were similar in the two groups. No complications were reported in either group. Conclusion For the fixation of Weber B fibular fractures, cortical lag screws and cancellous position screws showed comparable clinical outcomes. Cancellous screws with plate fixation may offer a viable alternative in cases with poor bone quality or difficulty applying lag screw techniques.

Purpose: Ankle fractures are common in the orthopedic field. Lateral malleolar fractures are often treated with lag screws and locking plates. Cortical screws are typically used as lag screws to achieve absolute stability through compression. In osteoporotic bone, however, achieving sufficient compression with cortical screws can be challenging. Cancellous screws may offer better fixation in metaphyseal bone. This study compared the outcomes of using cortical screws as lag screws and cancellous screws as position screws for lateral malleolar fixation. Materials and Methods: This retrospective study included patients who underwent surgery for Weber type B ankle fractures at the authors’ hospital between March 2019 and March 2022. The patients were divided into two groups based on the screw type: cortical lag screws (n=70) and cancellous position screws (n=35). In both groups, a locking plate was applied in the same manner after screw fixation. The outcomes were evaluated using the visual analog scale (VAS), Olerud-Molander score (OMS), foot and ankle outcome score (FAOS), and foot function index (FFI). Complications, such as fixation failure, nonunion, and malunion, were recorded. Results: One hundred and five patients were included. The mean follow-up duration was 16 months (range, 12~28 months). The VAS (1.6±1.9 vs. 1.1±1.3, p=0.305), FFI (10.3±13.4 vs. 10.4±13.5, p=0.970), FAOS (83.0±14.4 vs. 83.5±14.4, p=0.899), and OMS (85.3±18.4 vs.84.7±17.6, p=0.910) scores were similar in the two groups. No complications were reported in either group. Conclusion For the fixation of Weber B fibular fractures, cortical lag screws and cancellous position screws showed comparable clinical outcomes. Cancellous screws with plate fixation may offer a viable alternative in cases with poor bone quality or difficulty applying lag screw techniques.

PURPOSE: The management of prenatally detected bilateral ureteropelvic junction obstruction (UPJO) remains controversial. We attempted to develop a treatment plan for patients with severe bilateral UPJO. MATERIALS AND METHODS: We evaluated the records of 13 patients with prenatally diagnosed grade 3 or more bilateral hydronephrosis that led to the postnatal diagnosis of severe bilateral UPJO. Ultrasonography and (99m)technetium mercaptoacetyltriglycine ((99m)Tc-MAG3) renal scans were performed within 1 month. Four renal units had grade 3 and 22 had grade 4 hydronephrosis. All 13 patients were managed by unilateral pyeloplasty, and the patients' mean age was 3 months. At 1 month postoperatively, we decided whether delayed surgery in the opposite renal unit was necessary according to the findings of ultrasonography and (99m)Tc-MAG3 scans. RESULTS: Of 13 patients, 11 underwent initial pyeloplasty on renal units with more severe hydronephrosis or lower relative renal function (RRF) on (99m)Tc-MAG3 scans. The remaining 2 patients simultaneously underwent percutaneous nephrostomy on renal units with a lower RRF and initial pyeloplasty on renal units with a higher RRF. In 5 patients, contralateral hydronephrosis had spontaneously improved at 1 month postoperatively, and 8 patients underwent delayed contralateral pyeloplasty at 2 months postoperatively. CONCLUSIONS: In children with severe bilateral UPJO, the non-operated renal units with grade 3 and some with grade 4 hydronephrosis improved spontaneously after unilateral pyeloplasty. Therefore, delayed pyeloplasty of the opposite side should be considered at 1 month following initial pyeloplasty.
Child ; Humans ; Hydronephrosis ; Infant, Newborn ; Nephrostomy, Percutaneous ; Ureteral Obstruction

PURPOSE: Abdominal computed tomography (CT) is a widely recognized method to diagnose patients with acute abdominal pain in the emergency departments (EDs). We aimed to investigate the current state and interpretations of abdominal CT performed in the ED of a tertiary university hospital. METHODS: This was a retrospective study based on an abdominal CT database and medical records of patients over 15 years of age, who had visited our ED between January 1 and December 31, 2013. The data collected included CT types, final interpretations, characteristics of the patients, and location of pain at the time of CT. RESULTS: A total of 1,978 abdominal CTs were performed among 1,923 patients during the research period. The most frequent organs involved in the major diagnosis were those in the urinary system, followed by the appendix, liver, large intestine, and gallbladder. The most frequently interpreted diagnoses in these organs were in the order of urinary stone, appendicitis, liver cirrhosis, infectious colitis, and acute cholecystitis. The most frequent location of pain was the right lower quadrant (429 cases, 21.7%), and the most frequently performed CT types were contrast-enhanced abdominal and pelvic CT (1,260 cases, 63.7%). CONCLUSION: Various interpretations were derived based on the abdominal CTs, ranging from critical to mild diseases and from common to rare diseases. Based on this study, we have developed a preliminary interpretation checklist for abdominal CTs.
Abdominal Pain ; Appendicitis ; Appendix ; Checklist* ; Cholecystitis, Acute ; Colitis ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Gallbladder ; Humans ; Intestine, Large ; Liver ; Liver Cirrhosis ; Medical Records ; Methods ; Rare Diseases ; Retrospective Studies ; Tomography, X-Ray Computed ; Urinary Calculi

OBJECTIVE: The purposes of this study were to analyze the current status of nursing informatics course and to develop the standardized curriculum in nursing informatics course based on competency. METHODS: Data were collected through two phases. In the first phase, a survey was conducted on 115 nursing institutions to analyze the current status of nursing informatics course. In the second phase, two-round delphi technique was developed to determine the priority and relative weight of contents in nursing informatics course. Final samples composed of both 43 nursing institutions and 11 nursing informatics experts. RESULTS: Out of 43 nursing schools, 13 nursing schools offered nursing informatics course. Nursing informatics was taught mostly to the second year and had 2 credits. About 54% of respondents disagreed that nursing informatics should be included in the license examination for Registered Nurse. The subject matrix by priority and relative weight and a standardized curriculum for nursing informatics were developed. CONCLUSION: Continuous application and revision of nursing informatics curriculum should be needed.
Competency-Based Education ; Curriculum* ; Surveys and Questionnaires ; Delphi Technique ; Licensure ; Nursing Informatics* ; Nursing* ; Schools, Nursing

PURPOSE: This study aims to review the appropriateness of the issued death certificates and autopsy reports and to evaluate the improvement points of these documents in accordance with the guidelines of the Korean Medical Association and the National Statistical Office. Moreover, this study also examines why the guideline is necessary for the credibility of these documents. METHODS: The death certificates and autopsy reports written by a training hospital were analyzed for a 12-month period, between December 2014 and November 2015. The reference to analysis was the “guidelines to medical certificate 2015” written by the Korean Medical Association, “World Health Organization (WHO) death certificate principle”, and “guideline leaflet,” as provided by the National Statistical Office. Two researchers analyzed the documents that were against the guidelines, and suggested improvement points. The analyzed variables were age, sex, issued date, direct cause of death, manner of death, location of death, and types of accident. The primary goal was to see the rate of issued documents written correctly according to the guidelines and to suggest possible improvement points. The secondary goal was to analyze the reason for accordance and discordance between researchers. RESULTS: There were a total of 603 death certificates and autopsy reports issued during the research period; 562 (93.2%) and 41 (6.8%) cases, respectively. As for the manner of death, 521 cases were “death from disease,” 64 were “external causes,” and 18 were “others or unknown” (86.4%, 10.6%, and 3.0%, respectively). As for the issued department, internal medicine and emergency medicine issued 301 (49.9%) and 126 (20.9%) documents, respectively. Of these, 139 (23.1%) cases were regarded to be in accordance with the guidelines, while 304 (50.4%) were considered to be discordant cases. Among the discordant cases, there were 177 (29.4%) cases that were the mode of death directly written to cause of death. As for the records of “period of occurrence to death” were recorded only 70 (11.7%) cases (including “unknown” 65 cases) and the others were blank. The Kappa number of analysis regarding the evaluation correspondence of the two researchers was 0.44 (95% confidence interval, 0.38 to 0.51). CONCLUSION: The most frequent error was ‘the condition of death to direct cause of death’ with the ratio of 29.4%. This may have been because the rate of concordance between the researchers based on the guidelines was not high enough. There is a need to provide specific guidelines for each case, and also promote and educate regarding significant errors.
Autopsy ; Cause of Death ; Death Certificates* ; Emergency Medicine ; Internal Medicine ; Medical Errors ; Observational Study*

Objective: The Surviving Sepsis Campaign (SSC) guidelines have been associated with reduced mortality in sepsis patients. On the other hand, previous studies were performed using the Sepsis-2 definitions and past guidelines. This study assessed the association between compliance with the 2016 SSC guidelines and the outcomes of patients with sepsis and septic shock in accordance with the latest Sepsis-3 definitions. Methods: Three hundred and fifteen patients with sepsis and septic shock were enrolled in this study. The patients were stratified according to their compliance with the SSC guidelines bundle. The characteristics and outcomes of the compliance and non-compliance groups were compared. In the overall patients, the risk factors for all-cause mortality were assessed using Cox proportional hazards models. Results: Among the patients, 172 and 143 patients were in the compliance group and non-compliance group, respectively. The baseline characteristics and disease severity were similar in the two groups. The all-cause mortality rates were 27.3% and 38.5% in the compliance group and non-compliance group, respectively (P=0.035). The all-cause mortality was significantly lower in the compliance group than in the non-compliance group (log-rank test, P=0.025). The risk factors for the all-cause mortality were age (adjusted hazard ratio [aHR], 1.025; 95% confidence interval [CI], 1.008-1.042; P=0.004), septic shock (aHR, 3.14; 95% CI, 1.98-4.98; P<0.001), and lactate levels (aHR, 1.08; 95% CI, 1.03-1.14; P=0.002). The overall compliance with the guidelines protected against all-cause mortality (aHR, 0.66; 95% CI, 0.45-0.98; P=0.040). Conclusion Compliance with the SSC guidelines bundle was associated with a lower all-cause mortality among patients with sepsis and septic shock