BACKGROUND/AIMS: Do-Not-Resuscitate (DNR) orders have been one of the critical issues considered in futile medical management, but they have not been legally defined in Korea. The aim of this study was to observe the factors that influence DNR agreement and to determine the current status of DNR orders in the hemato-oncology wards of a university hospital, in which DNR orders were formally implemented through the Hospital Ethics Committee in October 2001. METHODS: We retrospectively analyzed the records of 213 patients who had died in the hemato-oncology department at a university hospital between January 2002 and July 2002. RESULTS: Of the 213 patients, 181 (85%) agreed to a DNR order. Cardiopulmonary resuscitation was done in 1 out of 181 patients. The DNRs were suggested by attending physicians in 83.9% of cases and by family members in 16.1%. The patients with more frequent admission to the hospital (3.7+/-2.6 vs. 2.9+/-1.7, p<0.05) and with higher educational level (p<0.05) were more likely to agree to a DNR order. Patients with gastrointestinal tract cancer were more likely to agree to a DNR order than patients with lung cancer or hematologic malignancy (p<0.05). The levels of care after DNR agreement were: withholding of resuscitation only (17.2%), withholding of additional support (73.9%), and active withdrawal of provided support (8.9%). CONCLUSIONS: The frequency of admission, type of malignancy, and educational level of patients were determining factors for the establishment of DNR orders in patients with malignancy.
Cardiopulmonary Resuscitation ; Ethics Committees, Clinical ; Gastrointestinal Neoplasms ; Hematologic Neoplasms ; Humans ; Korea ; Lung Neoplasms ; Medical Futility ; Resuscitation ; Retrospective Studies

Objectives: With the surge in the elderly population, a growing interest in the prevention and treatment of geriatric diseases has been observed, along with awareness of the severity of problems associated with dementia, a cognitive impairment. The purpose of this study was to investigate the correlation between chewing ability and cognitive function among elderly people residing in a rural area. Methods: A total of 162 elderly individuals, aged between 65 and 97 years, were surveyed. Trained examiners conducted interviews and assessments of chewing ability, on the basis of the number of remaining teeth, denture status, masticatory performance evaluating gum, ShadeEye-NCC measuring overall change in color of the gum (ΔE), and T-Scan® III analyzing distribution of occlusion patterns. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination-Dementia Screening (MMSE-DS) tool. Results: Participants with a low score in the MMSE-DS were found to have distinguishably lower denture need, smaller number of remaining teeth, and lesser color change in the masticatory performance evaluating gum. In the cognitive impairment group, a tendency of having unilateral and anterior occlusion led to occlusal discomfort and chewing difficulties. Conclusions The study highlights important associations between chewing ability and cognitive function. The finding corroborates that tooth loss may be a predictive risk factor for cognitive impairment.

Lectin-like oxidized low-density lipoprotein (LDL) receptor 1 (LOX1) binds to oxidized LDL, which is associated with inflammation in various vascular disorders. Here, we aimed to investigate the potential of soluble LOX1 (sLOX1) as an indicator of antineutrophil cytoplasmic antibody-associated vasculitis (AAV) activity. Serum levels of sLOX1 in frozen samples from patients with AAV enrolled in a prospective observational cohort study at the Severance Hospital were measured using enzyme-linked immunosorbent assay. Clinical and laboratory data were collected on the date when the blood sampling was performed. The association between sLOX1 and clinical and laboratory data was assessed using Pearson’s correlation analysis. The median age of the recruited 79 patients was 62.0 years, and 27 (34.2%) patients were men. The median Birmingham vasculitis activity score (BVAS), five-factor score, vasculitis damage index, and sLOX1 level were 6, 1, 3, and 911.9 pg/mL, respectively. Correlation analysis based on BVAS revealed that sLOX1 and total cholesterol were significantly inversely correlated with BVAS (r=-0.224, p=0.047 and r= -0.424, p<0.001, respectively). No significant correlations were observed between continuous variables and sLOX1 except for BVAS, although total cholesterol tended to correlate with sLOX1 (r=0.190, p=0.093). Additionally, sLOX1 was not influenced by sex, hypertension, diabetes mellitus, or the presence of pulmonary, cardiovascular, and renal involvement of AAV. In summary, sLOX1 was inversely correlated with BVAS in AAV patients, which is different from other vascular diseases or inflammatory diseases.

Objectives: With the surge in the elderly population, a growing interest in the prevention and treatment of geriatric diseases has been observed, along with awareness of the severity of problems associated with dementia, a cognitive impairment. The purpose of this study was to investigate the correlation between chewing ability and cognitive function among elderly people residing in a rural area. Methods: A total of 162 elderly individuals, aged between 65 and 97 years, were surveyed. Trained examiners conducted interviews and assessments of chewing ability, on the basis of the number of remaining teeth, denture status, masticatory performance evaluating gum, ShadeEye-NCC measuring overall change in color of the gum (ΔE), and T-Scan® III analyzing distribution of occlusion patterns. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination-Dementia Screening (MMSE-DS) tool. Results: Participants with a low score in the MMSE-DS were found to have distinguishably lower denture need, smaller number of remaining teeth, and lesser color change in the masticatory performance evaluating gum. In the cognitive impairment group, a tendency of having unilateral and anterior occlusion led to occlusal discomfort and chewing difficulties. Conclusions The study highlights important associations between chewing ability and cognitive function. The finding corroborates that tooth loss may be a predictive risk factor for cognitive impairment.

. Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is an autoimmune disease (AID) characterised by necrotising intravascular inflammation. Growing evidence suggests that immune system triggers altered lipid metabolism in AIDs. We investigated whether changes in lipid profile correlate with severity of disease in AAV. Methods. Seven lipid profiles were evaluated utilizing frozen serum samples from 67 patients registered in the Severance Hospital ANCA-associated VasculitidEs cohort by a chemistry autoanalyzer. The Birmingham Vasculitis Activity Score (BVAS) version 3 was used to measure patient’s assessment of global disease activity. The relationship between the BVAS with continuous variables was calculated by Pearson’s correlation analysis. Results. Thirty-five (52.2%), 19 (28.4%), and 13 (19.4%) patients were diagnosed with microscopic polyangiitis, granulomatosis with polyangiitis, and eosinophilic granulomatosis with polyangiitis, respectively. Patients’ mean age was 60.0 years, and 22 (32.8%) were male. Among the lipid profiles investigated, total cholesterol, high-density lipoprotein, and low-density lipoprotein, and apolipoprotein A1 and B were significantly associated with BVAS; apolipoprotein A1 showed the highest correlation with BVAS (r=−0.521, p＜0.001), remaining consistent even in patients with new-onset disease (r=−0.430, p=0.012). Apolipoprotein A1 had the highest association with the renal manifestation score among the clinical scores comprising BVAS (r=−0.457, p＜0.001). Conclusion. Decreased lipid levels, especially apolipoprotein A1, are relevant to increased AAV disease activity, and differ according to organ involvement. Measuring lipid profiles could have clinical implications regarding the assessment of global disease activity and organ involvement patterns.

Purpose: We investigated whether serum clusterin levels could reflect the current antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV)-specific indices. Materials and Methods: Fifty-seven patients with AAV and 40 healthy controls were included in this study. AAV-specific indices included the Short-Form 36-Item Health Survey Physical and Mental Component Summaries (SF-36 PCS and MCS) scores, Birmingham vasculitis activity score (BVAS), five-factor score (FFS), and vasculitis damage index. Clinical and laboratory data and AAV-specific indices were obtained at blood collection. The highest tertile of BVAS (≥16) was defined as high activity of AAV. Results: The median age of AAV patients was 64.0 years and 19 patients were male. SF-36 PCS score (r=0.328), SF-36 MCS score (r=0.289), BVAS (r=-0.404), erythrocyte sedimentation rate (r=-0.336), and C-reactive protein levels (r=-0.421) were significantly correlated with serum clusterin levels. In the multivariable linear regression analysis using AAV-specific indices and serum clusterin levels, both FFS (β=0.412) and serum clusterin levels (β=-0.250) were significantly associated with BVAS. When the optimal serum clusterin cut-off level for high activity of AAV was identified as 130.45 μg/mL, patients with serum clusterin level ≤130.45 μg/mL had a significantly higher risk for high activity of AAV than did those without (relative risk 7.194). Patients with AAV exhibited significantly lower serum clusterin levels than did healthy controls (168.2 μg/mL vs. 230.5 μg/mL). Conclusion Serum clusterin levels could reflect the current disease activity in patients with AAV.

OBJECTIVES: The purpose of this study was to investigate the job satisfaction level of the dental staff working at oral health centers for people with disabilities. METHODS: A questionnaire survey was conducted with 73 dentists and dental hygienists working at seven regional oral health centers for people with special needs and dental hospitals for people with disabilities in Seoul. The questionnaire consisted of seven questions across two subscales: general satisfaction (4 questions) and satisfaction with wage and welfare (3 questions). The internal consistency of the questionnaire items was assessed using Cronbach's alpha (0.80). The responses were analyzed using a t-test with SPSS (version 23.0). RESULTS: Of the 73 dental staff members, 50% were dentists, 64% were women, and participants' average age was 30 years. In total, 58% of the participants had up to five years of experience working with people with disabilities, 42% of them worked full-time, and each participant treated an average of 200 patients with disabilities per month. The participants reported that their salary was relatively low. Dental hygienists had higher satisfaction level than dentists in the institution's welfare work. The more full-time workers answered, the more suitable they are for their work. CONCLUSIONS: The job satisfaction level of most professionals working in oral health centers for people with disabilities was not very high but they felt rewarded by their welfare work. It was inferred that it is necessary to examine and improve institutional support aspects such as human resource support. Increasing the number of centers in the central region is also needed.
Dental Hygienists ; Dental Staff ; Dentists ; Disabled Persons ; Female ; Humans ; Job Satisfaction ; Oral Health ; Reward ; Salaries and Fringe Benefits ; Seoul

Purpose: We investigated whether serum clusterin levels could reflect the current antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV)-specific indices. Materials and Methods: Fifty-seven patients with AAV and 40 healthy controls were included in this study. AAV-specific indices included the Short-Form 36-Item Health Survey Physical and Mental Component Summaries (SF-36 PCS and MCS) scores, Birmingham vasculitis activity score (BVAS), five-factor score (FFS), and vasculitis damage index. Clinical and laboratory data and AAV-specific indices were obtained at blood collection. The highest tertile of BVAS (≥16) was defined as high activity of AAV. Results: The median age of AAV patients was 64.0 years and 19 patients were male. SF-36 PCS score (r=0.328), SF-36 MCS score (r=0.289), BVAS (r=-0.404), erythrocyte sedimentation rate (r=-0.336), and C-reactive protein levels (r=-0.421) were significantly correlated with serum clusterin levels. In the multivariable linear regression analysis using AAV-specific indices and serum clusterin levels, both FFS (β=0.412) and serum clusterin levels (β=-0.250) were significantly associated with BVAS. When the optimal serum clusterin cut-off level for high activity of AAV was identified as 130.45 μg/mL, patients with serum clusterin level ≤130.45 μg/mL had a significantly higher risk for high activity of AAV than did those without (relative risk 7.194). Patients with AAV exhibited significantly lower serum clusterin levels than did healthy controls (168.2 μg/mL vs. 230.5 μg/mL). Conclusion Serum clusterin levels could reflect the current disease activity in patients with AAV.

Purpose: The present study investigated and compared the antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) activity-predicting ability of the serum concentrations of the four interleukin (IL)-12 family cytokines including IL-23, IL-27, IL-35, and IL-39 in patients with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA). Materials and Methods: The present study included 70 patients with MPA and GPA. Clinical and laboratory data, particularly Birmingham Vasculitis Activity Score (BVAS), at the time of blood collection were obtained. The serum concentrations of IL-23, IL-27, IL-35, and IL-37 were measured using sera stored at -80°C. Patients were divided into two groups: the upper half of BVAS (BVAS ≥12) and the lower half of BVAS (BVAS <12). Results: The serum concentrations of IL-23 and IL-27 reflected AAV activity. Patients with the upper half of BVAS exhibited significantly higher serum concentrations of IL-23 and IL-27 than those without. Patients with the serum concentrations of IL-23 ≥132.1 pg/mL or IL-27 ≥684.7 pg/mL exhibited higher frequency and risk for the upper half of BVAS than those without [relative risks (RR) 5.143 and RR 4.091, respectively]. The serum concentrations of IL-27 were associated with age ≥65 years and proteinase 3-ANCA (or C-ANCA) negativity, whereas, those of IL-23 were associated with MPA. However, the serum concentrations of IL-35 and IL-39 were not useful in predicting AAV activity in this study. Conclusion The present study is the first to demonstrate that among the various members of IL-12 family cytokines, the serum concentrations of IL-23 and IL-27 possess AAV activity-predicting ability.

BACKGROUND: Strains of ciprofloxacin-resistant Klebsiella pneumoniae have emerged worldwide. We investigated the epidemiology of ciprofloxacin resistance and its relationship to ESBL production in nosocomial K. pneumoniae bacteremia. MATERIALS AND METHODS: Using the computerized database of clinical microbiology, we identified all patients whose blood culture had yielded K. pneumoniae between January 2001 and December 2002 at a 2200-bed university-affiliated tertiary-care hospital. During the study period, total of 392 episodes of K. pneumoniae bacteremia were documented of which 163 episodes were acquired nosocomially. 9 cases of recurrent episodes were excluded. RESULTS: The resistance rates to ciprofloxacin was 28.6% (44/154). ESBL-production was significantly more common in ciprofloxacin-resistant isolates than in ciprofloxacin-susceptible isolates (95.9% [42/44] vs. 24.5% [27/110], P<0.001). In univariate analysis, following factors were significantly associated with resistance to ciprofloxacin: older age, male sex, ICU admission at the time of bacteremia, prior use of antibiotics within 1 month before bacteremia, solid tumor, hematological malignancy, or biliary disease as underlying disease, and ESBL-production. The prior use of 3rd- generation cephalosprins, metronidazole, fluroquinolone, or carbapenem were also risk factors. Independent risk factors for ciprofloxacin resistance were older age (adjusted odds ratio [AOR]; 1.04, 95% confidence interval [CI]; 1.01-1.06) and ESBL production (AOR; 81.35, 95% CI; 17.76-372.53). CONCLUSION: The close relationship between ciprofloxacin resistance and ESBL production was documented in nosocomial K. pneumoniae bacteremia. Further epidemiological and molecular studies to determine factors and mechanisms involved in the relationship are needed.
Anti-Bacterial Agents ; Bacteremia* ; beta-Lactamases* ; Ciprofloxacin* ; Epidemiology ; Hematologic Neoplasms ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Male ; Metronidazole ; Odds Ratio ; Pneumonia ; Risk Factors