The purpose of this study was to investigate the impact of depression, discomfort, spirituality, physical care, and opioid use on pain with terminally ill cancer patients residing in hospice units. The convenient sample of this study consisted of 41 terminally ill cancer patients at three hospice units in university affiliated hospitals. Patients were interviewed with structured questionnaires three times at predetermined intervals: admission to the hospice unit (Time 1), one week later (Time 2), and two weeks later (Time 3). The data was collected from January 1998 to January 1999 and was analyzed using ANOVA, Pearson correlation coefficient, and multivariate multiple regression. The results of this study were as follows: 1. The mean age of the participants was approximately 55 years old. In terms of diagnosis, lung cancer showed the highest frequency (19.5%), followed by stomach cancer and rectal cancer (17.1%). The motive of seeking hospice unit admission was control (72. 2%), followed by spiritual care (50%), and symptom relief (38.9%). 2. Regarding the type of pain felt, the highest pain frequency the participants experienced was deep pain (55%), followed by multiple pain (25%), intestinal pain (10%), then superficial (5%) and neurogenic pain (5%). For the level of pain measured by VAS, there was no significant difference among the three time points; Time 1 (5.04 +/-2.21), Time 2 (4.82+/-2.58) and Time 3(4.73+/-2.51). 3. There was significant change seen in spirituality and physical care in each time interval. Namely, the longer the length of admission at the hospice unit, the higher the importance of spirituality (p=0.0001) and the more the physical care the participants received (p=0.01). The opioid use at the three time points showed the following frequencies : Time 1 (75.6%), Time 2 (85.4%) and Time 3 (75.6%). 4. Regarding factors influencing pain, the pain level was significantly affected by the depression level (p <0.01) and the opioid use (p <0.1). These results were the most significant at the two time points (Time 1 and Time 2). At Time 3 (two weeks later), the pain level was significantly affected by the depression level (p <0.05) and the amount of physical care the participants received (p <0.1). In conclusion, the terminally ill cancer patients had moderate pain, were generally depressed, and were treated with opioid analgesics. As approaching death, the patients received more physical care due to increased physical symptoms experienced and they had a higher perception of the importance of spirituality. Thus, health care professionals need to provide continuous care for each of them to die comfortably physically, psycho- logically, and spiritually.
Analgesics, Opioid ; Delivery of Health Care ; Depression ; Diagnosis ; Hospices* ; Humans ; Logic ; Lung Neoplasms ; Middle Aged ; Surveys and Questionnaires ; Rectal Neoplasms ; Spirituality ; Stomach Neoplasms ; Terminally Ill*

PURPOSE: Obesity, a worldwide epidemic, is associated with insulin resistance, hyperlipidemia, hypertension, cardiovascular disease, and certain cancers. Many strategies, including natural alternative anti-obesity agents, are used widely to prevent obesity. This study examined the effects of silkworm hemolymph on the weight control of C57BL/6N mice fed with a high-fat diet. METHODS: The mice were divided into five groups: normal group (N), high-fat diet group (HFC), high-fat diet and silkworm hemolymph (at dose of 1 mL/kg BW (HFS-1), 5 mL/kg BW (HFS-5) and 10 mL/kg (HFS-10) for 12 weeks. RESULTS: After 12 weeks treatment, the administration of silkworm hemolymph decreased the final body weight significantly along with a decrease in the weights of epididymal fat and total fat. The plasma LDL-cholesterol concentration was significantly lower in the HFS-1, HFS-5, and HFS-10 groups than in the HFC group. In addition, the leptin level of the HFS groups was significantly lower than those of the HFC group without a change in the plasma insulin concentration. CONCLUSION: These findings suggest that the silkworm hemolymph may have the potential to prevent obesity.
Animals ; Anti-Obesity Agents ; Body Weight ; Bombyx* ; Cardiovascular Diseases ; Diet, High-Fat* ; Hemolymph* ; Hyperlipidemias ; Hypertension ; Insulin ; Insulin Resistance ; Leptin ; Mice* ; Obesity ; Plasma ; Weights and Measures

PURPOSE: Clostridium difficile (C. difficile) is an important cause of nosocomial diarrhea. Diagnostic methods for detection of C. difficile infection (CDI) are shifting to molecular techniques, which are faster and more sensitive than conventional methods. Although recent advances in these methods have been made in terms of their cost-benefit, ease of use, and turnaround time, anaerobic culture remains an important method for detection of CDI. MATERIALS AND METHODS: In efforts to evaluate a novel chromogenic medium for the detection of C. difficile (chromID CD agar), 289 fecal specimens were analyzed using two other culture media of blood agar and cycloserine-cefoxitin-fructose-egg yolk agar while enzyme immunosorbent assay and polymerase chain reaction-based assay were used for toxin detection. RESULTS: ChromID showed the highest detection rate among the three culture media. Both positive rate and sensitivity were higher from chromID than other culture media. ChromID was better at detecting toxin producing C. difficile at 24 h and showed the highest detection rate at both 24 h and 48 h. CONCLUSION: Simultaneous use of toxin assay and anaerobic culture has been considered as the most accurate and sensitive diagnostic approach of CDI. Utilization of a more rapid and sensitive chromogenic medium will aid in the dianogsis of CDI.
Chromogenic Compounds/chemistry ; Clostridium difficile/chemistry/*isolation & purification ; Culture Media/*chemistry

We report a recent case in which ciprofloxacin-resistant Shigella flexneri was isolated from a 23-yr-old female patient with a history of travel to India. Prior to her admission to our internal medicine department, she experienced symptoms of high fever and generalized weakness from continuous watery diarrhea that developed midway during the trip. S. flexneri was isolated from the stool culture. Despite initial treatment with ciprofloxacin, the stool cultures continued to show S. flexneri growth. In the susceptibility test for antibiotics of the quinolone family, the isolate showed resistance to ciprofloxacin (minimum inhibitory concentration [MIC], 8 microg/mL), norfloxacin (MIC, 32 microg/mL), ofloxacin (MIC, 8 microg/mL), nalidixic acid (MIC, 256 microg/mL), and intermediate resistance to levofloxacin (MIC, 4 microg/mL). In molecular studies for quinolone resistance related genes, plasmid borne-quinolone resistance genes such as qnrA, qnrB, qnrS, aac(6')-Ib-cr, qepA, and oqxAB were not detected. Two mutations were observed in gyrA (248C-->T, 259G-->A) and 1 mutation in parC (239G-->T). The molecular characteristics of the isolated S. flexneri showed that the isolate was more similar to the strains isolated from the dysentery outbreak in India than those isolated from Korea.
Anti-Bacterial Agents/pharmacology ; Bacterial Proteins/genetics/metabolism ; Drug Resistance, Bacterial/drug effects ; Dysentery, Bacillary/microbiology ; Feces/microbiology ; Female ; Humans ; India ; Mutation ; Quinolones/*pharmacology ; Shigella flexneri/drug effects/*isolation & purification/metabolism ; Travel ; Young Adult

In the RNA-based study, it is important to extract high-quality RNA. However, RNA extraction from Mycobacterium tuberculosis is problematic due to its thick, waxy cell wall rich in mycolic acid, which renders the cells resistant to lysis. Using TRIzol reagent and several powerful bead-beating steps, a high quantity of RNA was obtained.
Cell Wall ; Mycobacterium tuberculosis* ; Mycobacterium* ; Mycolic Acids ; RNA*

BACKGROUND: Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain. In recent studies, preemptive analgesia was useful for control of postoperative pain in patients undergoing TKA. In particular, cyclooxygenase-2 inhibitor (celecoxib) is recommended for preemptive analgesia. As a large amount of blood is lost during TKA, blood transfusion is often required. In this study, we evaluated the difference of intraoperative blood loss, complications of operation, and hemodynamic change between the celecoxib group and the control group in TKA surgeries. METHODS: A total of 58 patients who underwent TKA from January 2013 to June 2013 in our hospital were evaluated through a retrospective study. Patients in the celecoxib group received 200 mg of oral celecoxib 1 to 2 hours before TKA. Those in the control group received no medication 1 to 2 hours before TKA. Preoperative and postoperative hemoglobin level, estimated blood loss, infused fluid volume, and intraoperative complications (nausea, vomiting) were assessed. Mean blood pressure was recorded immediately, and 30, 60, and 90 minutes after spinal anesthesia, after transfer to the post anesthesia care unit. RESULTS: No significant differences in demographic data (age, height, weight, operation time, nausea, and vomiting) were observed between the two groups. The intraoperative fluid volume of the celecoxib group was lower than that of the control group (782.8+/-240.6 vs 1382.4+/-369.2; P<0.05). No differences in hemodynamic changes (intraoperative blood pressure) were observed between the two groups. CONCLUSION: Perioperative use of an inhibitor of cyclooxygenase 2 is an effective component of multimodal analgesia, which has no effect on hemodynamic change and side effects during TKA.
Analgesia* ; Anesthesia ; Anesthesia, Spinal ; Arthroplasty* ; Blood Pressure ; Blood Transfusion* ; Cyclooxygenase 2 ; Hemodynamics ; Humans ; Intraoperative Complications ; Knee* ; Nausea ; Pain, Postoperative ; Retrospective Studies ; Celecoxib

BACKGROUND/AIMS: The aim of the study was to investigate the gastric involvement of Orientia tsutsugamushi and the relationship between the clinical features and gastritis in patients with scrub typhus. METHODS: The study included 98 patients who had been diagnosed with scrub typhus between January 2003 and December 2006. Sixteen patients were selected to undergo gastroduodenoscopy with endoscopic biopsy for molecular study. The clinical severity index score (CSIS) was evaluated. Rickettsial DNA was amplified using the paraffin- embedded biopsy tissue by performing nested PCR. The expressions of ICAM-1 and VCAM-1 were investigated by immunohistochemistry to evaluate their roles in the pathogenesis of scrub typhus. RESULTS: The endoscopic findings were gastritis (n=1), erosion (n=4) and ulcer (n=11). The average CSIS was 3.65+/-1.09. Four cases of nested PCR of the 16 gastric mucosal biopsies were positive. The gastric samples that were taken earlier after therapy tended to be PCR-positive (2.00+/-00 days vs. 3.83+/-1.27 days, p<0.001). There was no difference of the clinical features and the CSISs between the PCR-positive and PCR-negative patients. The biopsied tissue revealed no vasculitis findings. Staining for ICAM-1 was more expressed in the scrub typhus group as compared with the normal control group. Staining for VCAM-1 was sporadically expressed in the scrub typhus group and normal control group. In comparison with the patients with Helicobacter pylori-associated gastritis, the immunohistochemical staining showed no difference of expression in the patients with O. tsutsugamushi-infected gastritis. CONCLUSIONS: The gastritis seen in scrub typhus patients could be typhus that is related to the direct involvement of O. tsutsugamushi. The increased expression of ICAM-1 may be related with gastric mucosal endothelial injury due to direct infection.
Biopsy ; DNA ; Gastritis ; Helicobacter ; Humans ; Immunohistochemistry ; Intercellular Adhesion Molecule-1 ; Orientia tsutsugamushi ; Polymerase Chain Reaction ; Scrub Typhus ; Typhus, Epidemic Louse-Borne ; Ulcer ; Vascular Cell Adhesion Molecule-1 ; Vasculitis

No abstract available.
Acupuncture Therapy ; Ampicillin/pharmacology/therapeutic use ; Ankle/ultrasonography ; Anti-Bacterial Agents/pharmacology/therapeutic use ; Cellulitis/complications/diagnosis/drug therapy/*microbiology ; Diabetes Mellitus, Type 2/complications ; Gram-Negative Bacterial Infections/complications/diagnosis/drug therapy/*microbiology ; Humans ; Hypertension/complications ; Magnetic Resonance Imaging ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Prevotella nigrescens/drug effects/*genetics/isolation & purification ; RNA, Ribosomal, 16S/*analysis ; Sulbactam/pharmacology/therapeutic use ; Tomography, X-Ray Computed

Small cell carcinoma of the cervix has been traditionally considered a rare subtype ofsquamous cell carcinoma characterized by a highly malignant behavior. However, it has becomeobvious that the majority of small cell carcinomas of the cervix expresses neuroendocrine,not squamous, differentiation. One case of intermediate cell neuroendocrine carinoma andthree cases of small cell undifferentiated carcinoma were reported. Patients ranged in age from37 to 50 (median, 44years) and presental as stages Ib(two patients), IIa(one patient), andIIb(one patient). One cases of intermediate cell neuroendocrine carinoma was combined with-endocervical adenocarcinoma and one case of small cell undifferentiated carcinoma was combinedwith adenocarcinoma in situ. All 4 tumors expressed one or more epithelial markers andneuroendocrine markers. Electron microscopically, neuroendocrine granules were observed inall 4 cases but large amount in intermediate cell neuroendocrine carinoma. A variety of treatmentregimens was employed. One patient with intermediate cell neuroendocrine carinoma isalive now for 60 months after starting of treatment. But two of three patients with small cellundifferentiated carcinoma died of disease (34, 45 months) and one of them is alive now for20 months. One patient had spinal metastasis and paraplegia which were treated twice withsurgery and irradiation on tumor bed and the other patient was comatose with multiple livermetastasis. Small cell undifferentiated carcinoma of the cervix was more aggressive thanintermediate cell neuroendocrine carcinoma of the cervix. We can differentiate small cellundifferentiated carcinoma of the cervix from intermediate cell neuroendocrine carcinoma of thecervix, pathologically, ultrastructurally and immunocytochemically.
Adenocarcinoma ; Carcinoma ; Carcinoma, Neuroendocrine ; Carcinoma, Small Cell* ; Cervix Uteri* ; Coma ; Female ; Humans ; Neoplasm Metastasis ; Paraplegia

BACKGROUND: Transfusion service, as a task directly affecting the patient's life, must be performed as expeditiously as possible. However, for various reasons, we have experienced difficulty in supplying blood products in a timely manner. In this study, we analyzed the turnaround time (TAT) of blood issue and attempted to find a solution. METHODS: We evaluated the TATs for the request and preparation of blood transfusions in our hospital from January to December 2011. The time of blood issue, from acceptance of the request to preparation in the blood bank, was calculated from computerized medical records. In cases in which the TAT exceeded 24 hours, we investigated the type of blood component and the cause of the delay. RESULTS: A total of 12,856 units of blood were issued during the study year. Of these, 1,333 units (10.4%) had TATs exceeding 24 hours. These units included 148 units of red blood cells (RBC) (2.1%), 49 units of leukocyte-filtered red blood cells (F-RBC) (69.0%), 92 units of fresh frozen plasma (FFP) (3.9%), six units of cryoprecipitates (CRYO) (7.4%), 818 units of platelets (PLT) (27.1%), and 220 units of apheresis platelets (A-PLT) (66.5%). The preparation times for PLT and A-PLT were more delayed. The cause of the delays was lack of inventory at the blood center. CONCLUSION: We recommend that the blood center keep blood products even at the risk that they will be discarded for exceeding the expiration date. In addition, we suggest that testing of donated blood be performed within the region.
Blood Banks ; Blood Component Removal ; Blood Platelets ; Blood Transfusion ; Erythrocytes ; Medical Records Systems, Computerized ; Plasma