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*

OBJECTIVES: The present study was performed to evaluate whether naltrexone treatment are effectively lowering the urge of alcohol drinking, and to investigate the its mechanism of action. METHODS: 15 healthy male social drinkers were voluntarily participated. The experimental method was double-blind placebo-controlled cross over design. Subjects ingested a naltrexone (50mg)/day or placebo for 1 week. Plasma beta-endorphin, plasma ACTH and serum cortisol levels were measured before, at 20 minutes and at 60 minutes after alcohol exposure. Subjects completed self-report questionnaires such as the visual analog scales of drink urge and the alcohol sensation scales at regular intervals. RESULTS: 1) During naltrexone pretreatment period, subjects reported more headache, dizziness, nervousness, fatigue, day somnolence, nausea, and decreased appetite than placebo pretreatment period. But serum GOT/GPT levels were not significantly different between two pretreatment periods. 2) In case of naltrexone pretreatment, subjects reported significantly less urge to alcohol drink on the self-reporting urge scales, especially at post-drinking 20 minutes and 60 minutes than placebo pretreatment. 3) After alcohol challenge, subjects reported significantly more dizziness on the alcohol sensation scales in case of naltrexone pretreatment, and reported less mood elevation trend though it was not statistically significant. Other scores were not significantly different between two pretreatments. 4) Plasma beta-endorphin levels were significantly different when treated with naltrexone. In case of naltrexone-pretreatment, the increasing degree of plasma beta-endorphin during 20 minutes after alcohol challenge was significantly higher than placebo pretreatment. 5) Basal plasma ACTH level and basal serum cortisol level were not significantly different between two pretreatments. After alcohol challenge, only the decreasing degree of plasma ACTH levels during 20 minutes was significantly lowered in the naltrexone pretreatment than placebo pretreatment. CONCLUSIONS: Naltrexone reduced urge to alcohol drinking in social drinker. The action mechanism of naltrexone may be partially blocking opioid positive reward system and partially alcohol mimicking its property.
Adrenocorticotropic Hormone ; Alcohol Drinking ; Anxiety ; Appetite ; beta-Endorphin* ; Cross-Over Studies ; Dizziness ; Fatigue ; Headache ; Humans ; Hydrocortisone ; Male ; Naltrexone* ; Nausea ; Plasma* ; Surveys and Questionnaires ; Reward ; Sensation ; Visual Analog Scale ; Weights and Measures

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

OBJECTIVES: The differentiation of tuberculous effusion from the other causes of exudative pleural effusion remained difficult even with aids of biochemical analyses and pleural biopsy. As the pathophysiology of tuberculous pleural effusion is an enhanced cell mediated immunity, Adenosine deaminase(ADA) and various cytokines including Inteferon-γ, tumor necrosis factor alpha(TNF-α) are considered as useful diagnostic tools in differentiating exudative pleural effusion The author would like to demonstrate the diagnostic usefulness of TNF-α in the differentiation of exudative pleural effusion, and compared the discriminating ability of TNF-α with ADA. METHODS: Pleural fluids obtained from 80 patients (tuberculous : 39, malignant : 31, parapneumonic : 10) with exudate pleural effusions were processed for cell counts and biochemical analysis including ADA and TNF-α RESULTS: Tuberculous pleural fluid showed higher levee of ADA and TNF-α, 48.7α 32.7U/L and 184.1±214.2pg/mL than that of non-tuberculous effusion 26.0α41.3U/L and 44.1α114.2pg/mL, respectively (ADA, TNF-α : p<0.05, p<0.01). Receiver operating characteristics(ROC) curves were generated for ADA and TNF-α, and the best cut-off value for adenosine deaminase and TNF-α were considered as 30U/L and 15pg/ml, respectively. Comparing the area under the ROC curves, there was no significant difference between ADA and TNF-α CONCLUSION: For the differential diagnosis of tuberculous pleural effusion from the other causes of exudative pleural effusions, TNF-α as well as ADA was considered as useful diagnostic method. However adding TNF-α to ADA has no further diagnotic benefit than ADA alone.
Adenosine ; Adenosine Deaminase ; Biopsy ; Cell Count ; Cytokines ; Diagnosis, Differential ; Exudates and Transudates ; Humans ; Immunity, Cellular ; Pleural Effusion* ; ROC Curve ; Tuberculosis ; Tumor Necrosis Factor-alpha*

Dystrophinopathy, caused by mutations in the DMD gene, presents with variable clinical phenotypes ranging from the severe Duchenne muscular dystrophy (DMD) to the milder Becker muscular dystrophy(BMD) forms. DMD is a recessive X-linked form of muscular dystrophy. Two-thirds of mothers of affected males are thought to be DMD carriers. Approximately 2.5-7.8% of female DMD carriers have muscle weakness and are categorized as manifesting DMD carriers. The symptoms of female carriers of DMD range from mild muscle weakness to severe gait problems. The most commonly presented symptom is mild proximal muscle weakness, which is often asymmetric and progressive, but shows variable clinical spectrum with BMD of more severe DMD-like phenotype. Atypical presentations in manifesting carriers are myalgia or cramps without limb weakness, isolated cardiomyopathy and camptocormia. Multiplex PCR and MLPA analysis are common techniques to identify mutations in the DMD gene. Relationship between X-chromosome inactivation and clinical severity is not clear. Female carriers of DMD are not less common, and they have an important role of birth of a male DMD.
Cardiomyopathies ; Extremities ; Female* ; Gait ; Humans ; Male ; Mothers ; Multiplex Polymerase Chain Reaction ; Muscle Cramp ; Muscle Weakness ; Muscular Dystrophies ; Muscular Dystrophy, Duchenne* ; Myalgia ; Parturition ; Phenotype

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