BACKGROUND: Unlike other diseases, the management of sepsis has not been fully integrated in our daily practice. The aim of this study was to determine whether repeated training could improve compliance with a 6-h resuscitation bundle in patients with severe sepsis and septic shock. METHODS: Repeated education regarding a sepsis bundle was provided to the intensive care unit and emergency department residents, nurses, and faculties in a single university hospital. The educational program was led by a multidisciplinary team. A total of 175 adult patients with severe sepsis or septic shock were identified (88 before and 87 after the educational program). Hemodynamic resuscitation bundle and timely antibiotics administration were measured for all cases and mortality at 28 days after sepsis diagnosis was evaluated. RESULTS: The compliance rate for the sepsis resuscitation bundle before the educational program was poor (0%), and repeated training improved it to 80% (p < 0.001). The 28-day mortality was significantly lower in the intervention group (16% vs. 32%, p = 0.040). Within the intervention group, patients for whom the resuscitation bundle was successfully completed had a significantly lower 28-day mortality than other patients (11% vs. 41%, p = 0.004). CONCLUSIONS: Repeated education led by a multidisciplinary team and interdisciplinary communication improved the compliance rate of the 6-h resuscitation bundle in severe sepsis and septic shock patients. Compliance with the sepsis resuscitation bundle was associated with improved 28-day mortality in the study population.
Adult ; Anti-Bacterial Agents ; Compliance ; Critical Pathways ; Diagnosis ; Education ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Intensive Care Units ; Interdisciplinary Communication ; Mortality ; Resuscitation* ; Sepsis* ; Shock, Septic

This study identified an effective control method for periodontitis by investigating the association between blood levels of vitamin D and periodontitis in Korean elderly based on raw data from the fifth Korea National Health & Nutrition Examination Survey of 2010 (KNHANES). In this study, 1,021 adults over 65 years of age were evaluated based on data from the KNHANES. Periodontal disease was assessed using community periodontal index (CPI), with CPI codes ≥3 defined as periodontitis. Blood levels of vitamin D were measured from blood samples and divided into four groups (first quartile: ≤13.23 ng/ml, second quartile: 13.24∼16.95 ng/ml, third quartile: 16.96∼21.58 ng/ml), and fourth quartile >21.59 ng/ml). Using multiple logistic regression analyses, the variables were adjusted for general characteristics, oral health-related characteristics, health-related characteristics, and bone mineral density. The statistical analysis was performed using the SAS (ver. 9.2). The results of this study are as follows: the prevalence of periodontitis was 42.6% in Korean elderly. After adjusting for general, oral health-related, and health-related, the risk of periodontitis in the first quartile group was 1.74 times (95% confidence interval [CI], 1.02∼2.98) higher than that of the fourth quartile group (p=0.041). After adjusting for general, oral health-related, and health-related characteristics as well as bone mineral density, the risk of periodontitis in the first quartile group was 1.73 times (95% CI, 1.02∼2.96) higher than that of the four quartile group (p=0.042). There was a significant relationship between blood vitamin D level and periodontitis in Korean elderly. For the prevention of periodontitis, factors related to vitamin D should be considered along with other risk factors.
Adult ; Aged* ; Bone Density ; Humans ; Korea ; Logistic Models ; Methods ; Periodontal Diseases ; Periodontal Index ; Periodontitis* ; Prevalence ; Risk Factors ; Vitamin D* ; Vitamins*

No Abstract Available.
Receptors, Cytoplasmic and Nuclear*

No abstract available.
Basal Ganglia* ; Humans

No abstract available.
Knee Joint* ; Knee*

PURPOSE: To investigate the clinical results and safety of the acellular dermal allograft (SureDerm(R), Hans Biomed co., Korea) as a new spacer graft in anophthalmic socket contracture. METHODS: We grafted SureDerm(R) as the replacing spacer in 8 patients for the treatment of anophthalmic socket contracture. Under local anesthesia, SureDerm(R) was sutured at the levator aponeurosis and upper margin of the tarsus using 6-0 Vicryl in the upper lid. In the lower lid, SureDerm(R) was sutured at the tarsal conjunctiva and lower margin of the incised conjunctiva. The patients were followed-up individually for 6 to 15 months. RESULTS Surgical results in all 8 eyelids (6 lower lids, 2 upper lids) were satisfactory. The grafted SureDerm(R) survived in all patients with little contracture. There were no other complications such as infection, rejection, or exposure. CONCLUSIONS: We consider SureDerm(R) a good replacing spacer material for the treatment of anophthalmic socket contracture.
Allografts* ; Anesthesia, Local ; Ankle ; Conjunctiva ; Contracture ; Eyelids ; Humans ; Polyglactin 910 ; Transplants

No abstract available.
Membranes* ; Pregnancy* ; Rupture*

OBJECTIVES: There is a controversy on the mechanism of nicotine dependence. Some suggest that the negative reinforcement such as withdrawal symptoms plays an important role, but others suggest that the positive reinforcement through the opioid-dopamine system plays an important role. Under the assumptions that the positive reinforcement and the opioid-dopamine interaction to have an important role in nicotine dependence, this study examined the effects of chronic naltrexone treatment on smoking behaviors, smoking urges to smoking cues and neuroendocrine responses to smoking. METHODS: In a randomized, placebo-control, double-blind design, voluntarily admitted regular smokers who wanted to quit smoking received naltrexone (13 persons) or placebo (12 persons) treatment for 2 weeks. Each week, naltrexone side effects, discomforts after the reduction of cigarette smoking, smoking urges to smoking cues, daily cigarette smoking amount, and expiratory carbon monooxide levels were checked. Also blood beta-endorphin, dynorphin, prolactin, ACTH, and cortisol levels were measured before and after smoking. RESULTS: Naltrexone treatment group showed significantly reduced smoking urges to smoking cues (p=0.036 at 2nd week), daily cigarette smoking amount (p=0.027 at 1st week), and expiratory CO levels (p=0.002 at 1st week, p=0.039 at 2nd week). Naltrexone treatment group also showed significantly increase cortisol level after smoking during the 1st week (p=0.048), and ACTH and prolactin level during the 2nd week (respectively p=0.010, p=0.009). But, the levels of beta-endorphin and dynorphin A were not different between the two groups. Discomfort profiles after the reduction of cigarette smoking, systolic and diastolic BP, and pulse rates were not different between the two groups. CONCLUSION: Longterm naltrexone treatment could be an effective tool used for the cessdtion of smoking. It was suggested that naltrexone blocks the positive reinforcement effects of smoking rather than the negative reinforcement effects of nicotine withdrawal.
Adrenocorticotropic Hormone* ; Analgesics, Opioid* ; beta-Endorphin ; Carbon ; Cues ; Dynorphins ; Heart Rate ; Hydrocortisone* ; Naltrexone* ; Nicotine* ; Prolactin* ; Reinforcement (Psychology) ; Smoke* ; Smoking* ; Substance Withdrawal Syndrome ; Tobacco Use Disorder

PURPOSE: To investigate the trend of refractive change in hyperopic patients according to increases in age. METHODS: Eighty-eight children who had hyperopia of more than +1.50 diopters (D) and could be followed up for at least 5 years were included in this study. We divided the patients into two groups according to the level of initial hyperopia and retrospectively analyzed hyperopic refractive changes over a 5-year period according to age at initial diagnosis, presence of esotropia, amblyopia, astigmatism and anisometropia. RESULTS: We gained the following formula about the aspect of hyperopic reduction in 88 patients over a period of 5 years: Diopter (D)=7.99-2.14 Ln (age). The presence of anisometropia and amblyopia did not affect hyperopic reduction. Hyperopic reduction amounts in the group with a hyperopic eye of more than +5D at initial diagnosis were greater than in the group with a hyperopic eye less than +5D, and greater in the group with an astigmatic eye of more than 1D. The presence of esotropia and the age at initial diagnosis did not affect hyperopic reduction. CONCLUSIONS: We show that emmetropization in hyperopic children occurs according to the following formula: Diopter (D)=7.99-2.14 Ln (age). Both the initial level of hyperopia and the concurrent presence of astigmatism affected hyperopic reduction. However, the presence of anisometropia, amblyopia, esotropia and the age at initial diagnosis did not significantly affect hyperopic reduction.
Amblyopia ; Anisometropia ; Astigmatism ; Child ; Diagnosis ; Esotropia ; Follow-Up Studies* ; Humans ; Hyperopia ; Retrospective Studies

Dermatomyositis (DM) is an idiopathic inflammatory myopathy with bimodal onset age distribution. The age of onset is between 5-18 yr in juvenile DM and 45-64 yr in adult DM. DM has a distinct clinical manifestation characterized by proximal muscle weakness, skin rash, extramuscular manifestations (joint contracture, dysphagia, cardiac disturbances, pulmonary symptoms, subcutaneous calcifications), and associated disorders (connective tissue disease, systemic autoimmune diseases, malignancy). The pathogenesis of juvenile and adult DM is presumably similar but there are important differences in some of the clinical manifestations, associated disorders, and outcomes. In this study, we investigated the clinical characteristics and outcomes of 16 patients with juvenile DM and 48 with adult DM. This study recognizes distinctive characteristics of juvenile DM such as higher frequency of neck muscle involvement, subcutaneous calcifications, and better outcomes.
Adolescent ; Adult ; Age of Onset ; Aged ; Anti-Inflammatory Agents/therapeutic use ; Calcification, Physiologic ; Dermatomyositis/*diagnosis/mortality/therapy ; Exanthema/diagnosis ; Female ; Humans ; Male ; Middle Aged ; Muscle Weakness/diagnosis ; Prednisolone/therapeutic use ; Prognosis ; Severity of Illness Index ; Survival Rate