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 AND OBJECTIVES: The clinical outcome of patient with an acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI), with or without achievement of target low density lipoprotein-cholesterol (LDL-C), has little known information. This study investigated if target LDL-C level (below 70 mg/dL) achievements in patients with AMI showed better clinical outcomes or not. SUBJECTS AND METHODS: Between May 2008 and September 2012, this study enrolled 13473 AMI patients in a large-scale, prospective, multicenter Korean Myocardial Infarction (KorMI) registry. 12720 patients survived and 6746 patients completed a 1-year clinical follow up. Among them 3315 patients received serial lipid profile follow-ups. Propensity score matching was applied to adjust for differences in clinical baseline and angiographic characteristics, producing a total of 1292 patients (646 target LDL-C achievers vs. 646 non-achievers). The primary end point was the composite of a 1-year major adverse cardiac event (MACE) including cardiac death, recurrent myocardial infarction (MI), target lesion revascularization (TLR) and coronary artery bypass grafting. RESULTS: After propensity score matching, baseline clinical and angiographic characteristics were similar between the two groups. Clinical outcomes of the propensity score matched patients who showed no significant differences in cardiac death (0.5% vs. 0.5%, p=1.000), recurrent MI (1.1% vs. 0.8%, p=0.562), TLR (5.0% vs. 4.5%, p=0.649), MACEs (6.5% vs. 5.9%, p=0.644) and stent thrombosis (2.5% vs. 1.9%, p=0.560). CONCLUSION: In this propensity-matched comparison, AMI patients undergoing PCI with a target LDL-C (below 70 mg/dL) achievement did not show better clinical outcomes.
Coronary Artery Bypass ; Death ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Propensity Score ; Prospective Studies ; Stents ; Thrombosis ; Treatment Outcome

PURPOSE: The exact role of angiogenesis in prostate cancer is unknown. We investigated whether endocrine therapy inhibits angiogenesis, and influences the expression of thrombospondin-1 (TSP-1), a potent inhibitor of angiogenesis, and vascular endothelial growth factor (VEGF) in prostate cancer. MATERIALS AND METHODS: Employing immunohistochemistry, we assessed the expression of VEGF and TSP-1 in archival tissues from 46 patients with metastatic prostate cancer (30 before androgen deprivation therapy and 16 after at least 6-months' duration of androgen deprivation therapy). For each tumour, microvascular density (MVD) counts were determined using immunohistochemical staining for factor VIII. The relationship between MVD and the expression of VEGF and TSP-1, the tumour grade was assessed in metastatic prostate cancer. RESULTS: The mean MVD counts (71.1 vessels per 200x high-power field) in 16 patients with metastatic cancer after androgen deprivation therapy was significantly higher than that (51.7) in 30 patients before androgen deprivation therapy (p<0.05). The immunohistochemical analysis demonstrated a higher TSP-1 expression (p<0.01), and a lower VEGF expression (p<0.01), in androgen deprivation group. There was no significant correlation between VEGF or TSP-1 expression and the mean MVD counts. The MVD counts had no correlation with Gleason scores or initial PSA levels. CONCLUSIONS: Endocrine therapy in metastatic prostate cancer significantly decreased MVD counts, the expression of VEGF and significantly increased the expression of TSP-1. The present study shows that decreased angiogenesis including changes in the expressions of angiogenic factors, might have an important role in the therapeutic effect of androgen deprivation in metastatic prostate cancer.
Angiogenesis Inducing Agents ; Factor VIII ; Humans ; Immunohistochemistry ; Prostate* ; Prostatic Neoplasms* ; Thrombospondin 1 ; Vascular Endothelial Growth Factor A*

Hickman catheters are tunneled central venous catheters used for long-term venous access in children with malignancies. The appropriate management for various kinds of catheter related complications has become a major issue. We retrospectively analyzed the clinical, demographic, and surgical characteristics in 154 pediatric hemato-oncology patients who underwent Hickman catheter insertion between January 2005 and December 2009. There were 92 boys and 62 girls. The mean age at surgery was 7.6+/-5.1 years old. The mean operation time was 67.4+/-21.3 minutes and C-arm fluoroscopy was used in 47(30.5%). The causes of Hickman catheter removal were termination of use in 82 (57.3%), catheter related bloodstream infection in 44(30.8%), mechanical malfunction in 11(7.7%), and accidents in 6(4.2%). Univariate and multivariate analysis for associated factors with catheter related bloodstream infection showed that there were no statistically significant associated factors with catheter related infection complications. All cases except two showed clinical improvement with catheter removal and relevant antibiotics treatment. The mean catheter maintenance period in patients of catheter removal without complications was 214.9+/-140.2 days. And, The mean catheter maintenance period in patients of late catheter related bloodstream infection was 198.0+/-116.0 days. These data suggest that it is important to remove Hickman catheter as soon as possible after the termination of use. When symptoms and signs of complications were noticed, prompt diagnostic approach and management can lead to clinical improvements.
Anti-Bacterial Agents ; Catheters ; Central Venous Catheters ; Child ; Fluoroscopy ; Humans ; Multivariate Analysis ; Retrospective Studies

No abstract available.
Cellulitis

PURPOSE: When flexor tendons are injuried in children, the management is difficult. There are needs to determine the periods of postoperative immobilization. MATERIALS AND METHODS: From April 1994 to March 1998, 40 patients younger than 16 years who had sustained flexor tendon lacerations in zone I or zone II of 52 digits were available for critical evaluation. The average postoperative follow-up period was 24 (range, 3-48) months. RESULTS: All profundus repairs in zone I achieved excellent or good function. Isolated profundus and combined profundus and superficialis repairs in zone II achieved comparable results which managed with a passive motion program immediately after operation (TAM=82%) or motion following immobilization for 3 weeks (TAM =79%) or 4 weeks (TAM=78%) . Immobilization for longer than 4 weeks which resulted in an appreciable deterioration of funtion (5 weeks: TAM=64%, 6 weeks: TAM=61%) . Digital motion following flexor tendon injuries treated with less than 4 weeks of immobilization or early motion was not significantly different. CONCLUSION: We could find no benefits of early mobilization protocols in children. Howerver, it does appear that it is important that postoperative immobilization not be continued beyond 4 weeks.
Child* ; Early Ambulation ; Follow-Up Studies ; Hand* ; Humans ; Immobilization ; Lacerations ; Tendon Injuries ; Tendons*

PURPOSE: This study presents the clinical and radiological outcomes of cementless total hip arthroplasty using the COREN hip system after a minimum duration of follow-up of 5 years. MATERIALS AND METHODS: We evaluated the results of a consecutive series of the first 200 primary total hip arthroplasties that had been performed in our hospital in 169 patients between February 2007 and April 2011. Six patients (6 hips) had died within 5 years, and 12 patients (13 hips) had been lost to follow-up, leaving a total of 151 patients (181 hips) available for the study. All patients were evaluated clinically and radiologically with special attention to thigh pain, implant fixation, radiolucent line and osteolysis around implants. RESULTS: The mean Harris hip score improved from 59.4 preoperatively to 97.2 postoperatively. No patient complained of thigh pain. All implants demonstrated radiographic evidence of stable fixation by bone ingrowth without any change in position. No implant was loose radiographically or was revised. Eleven hips (7.7%) had a radiolucent line around the femoral stem. Focal osteolytic area was detected in 3 cases (2.1%). An osteolytic lesion was stabilized in 1 case and further observation was needed in 2 cases in which the lesions were detected several years after surgery. Stress shielding was observed in 80.3% of cases (first degree, 35.9%; second degree, 44.4%); there were no cases of third or fourth degree stress shielding. One case was complicated by bacterial infection and repeated dislocation. CONCLUSION: Mid-term results of total hip arthroplasty using the COREN hip system are very encouraging clinically and radiologically.
Arthroplasty ; Arthroplasty, Replacement, Hip ; Bacterial Infections ; Dislocations ; Follow-Up Studies ; Hip ; Humans ; Lost to Follow-Up ; Osteolysis ; Thigh

Fixed implant prostheses or removable partial dentures are common treatment for partially dentulous patients. Recently, an implant-assisted removable partial denture (IARPD) has been introduced and is widely used. In the case of removable partial dentures using implant attachment and surveyed fixed prostheses, the consideration about parallelism of insertion path between implants and surveyed fixed prostheses is an important factor for success of IARPDs. In this case, she complained of discomfort while using the mandibular removable partial denture. Thus, an IARPD using implant surveyed fixed prostheses was fabricated.Thereafter, more implants were placed by a digital guide surgery to have the same insertion path as the existing surveyed fixed prostheses. Locator attachments were installed to the left and right premolar implants, and the left molar was able to obtain support of the removable partial denture with healing abutment. The clinical results were satisfactory on the aspect of aesthetic and masticatory function.

BACKGROUND: Postoperative pressure ulcers are important indicators of perioperative care quality, and are serious and expensive complications during critical care. This study aimed to identify perioperative risk factors for postoperative pressure ulcers. METHODS: This retrospective case-control study evaluated 2,498 patients who underwent major surgery. Forty-three patients developed postoperative pressure ulcers and were matched to 86 control patients based on age, sex, surgery, and comorbidities. RESULTS: The pressure ulcer group had lower baseline hemoglobin and albumin levels, compared to the control group. The pressure ulcer group also had higher values for lactate levels, blood loss, and number of packed red blood cell (pRBC) units. Univariate analysis revealed that pressure ulcer development was associated with preoperative hemoglobin levels, albumin levels, lactate levels, intraoperative blood loss, number of pRBC units, Acute Physiologic and Chronic Health Evaluation II score, Braden scale score, postoperative ventilator care, and patient restraint. In the multiple logistic regression analysis, only preoperative low albumin levels (odds ratio [OR]: 0.21, 95% CI: 0.05–0.82; P < 0.05) and high lactate levels (OR: 1.70, 95% CI: 1.07–2.71; P < 0.05) were independently associated with pressure ulcer development. A receiver operating characteristic curve was used to assess the predictive power of the logistic regression model, and the area under the curve was 0.88 (95% CI: 0.79–0.97; P < 0.001). CONCLUSIONS: The present study revealed that preoperative low albumin levels and high lactate levels were significantly associated with pressure ulcer development after surgery.
Case-Control Studies ; Comorbidity ; Critical Care ; Erythrocytes ; Humans ; Lactic Acid ; Logistic Models ; Perioperative Care ; Pressure Ulcer ; Retrospective Studies ; Risk Factors ; ROC Curve ; Ventilators, Mechanical

OBJECTIVES: Triage is a process to accurately assess and classify symptoms to identify and provide rapid treatment to patients. The Korean Triage and Acuity Scale (KTAS) is used as a triage instrument in all emergency centers. The aim of this study was to train and compare machine learning models to predict KTAS levels. METHODS: This was a cross-sectional study using data from a single emergency department of a tertiary university hospital. Information collected during triage was used in the analysis. Logistic regression, random forest, and XGBoost were used to predict the KTAS level. RESULTS: The models with the highest area under the receiver operating characteristic curve (AUROC) were the random forest and XGBoost models trained on the entire dataset (AUROC = 0.922, 95% confidence interval 0.917–0.925 and AUROC = 0.922, 95% confidence interval 0.918–0.925, respectively). The AUROC of the models trained on the clinical data was higher than that of models trained on text data only, but the models trained on all variables had the highest AUROC among similar machine learning models. CONCLUSIONS: Machine learning can robustly predict the KTAS level at triage, which may have many possibilities for use, and the addition of text data improves the predictive performance compared to that achieved by using structured data alone.
Cross-Sectional Studies ; Dataset ; Emergencies ; Emergency Service, Hospital ; Forests ; Humans ; Logistic Models ; Machine Learning ; Natural Language Processing ; ROC Curve ; Triage