Background: Pneumonia, which is the third leading cause of death in South Korea, is continuously increasing with the aging society. The Health Insurance Review and Assessment of South Korea conducted a quality assessment (QA) for improving the outcome of community-acquired pneumonia (CAP). Methods: We conducted a nationwide cross-sectional study of hospitalized CAP in South Korea. First to third QA data were gathered into a single database. The national health insurance database was merged with the QA database for analyzing the medical claims data. Comorbidities, pneumonia severity, and pneumonia care appropriateness were calculated using Charlson comorbidity index (CCI), CURB-65, and core assessment of CAP scores (CAP scores), respectively. Results: Overall, 54,307 patients were enrolled. The CAP scores significantly improved on QA program implementation (P < 0.001). All the variables demonstrated an association with in-hospital mortality, hospital length of stay (LOS), and 30-day mortality in the univariate analyses. Following the adjustments, higher CCI and CURB-65 scores were associated with higher in-hospital mortality, longer hospital LOS, and higher 30-day mortality. Male sex was associated with higher in-hospital/30-day mortality and shorter hospital LOS. Higher CAP scores were associated with shorter hospital LOS (P < 0.001). Upon QA program implementation, in-hospital mortality (P < 0.001), hospital LOS (P < 0.001), and 30-day mortality (P < 0.001) improved. Conclusion Continuing QA program is effective in improving the clinical outcomes of hospitalized CAP.

PURPOSE: Pharmacologic thromboprophylaxis is routinely recommended for Western cancer patients undergoing major surgery for prevention of venous thromboembolism (VTE). However, it is uncertainwhetherroutine administration of pharmacologic thromboprophylaxis is necessary in all Asian surgical cancer patients. This prospective study was conducted to examine the incidence of and risk factors for postoperative VTE in Korean colorectal cancer (CRC) patients undergoing major abdominal surgery. MATERIALS AND METHODS: This study comprised two cohorts, and none of patients received perioperative pharmacologic thromboprophylaxis. In cohort A (n=400), patients were routinely screened for VTE using lower-extremity Doppler ultrasonography (DUS) on postoperative days 5-14. In cohort B (n=148), routine DUS was not performed, and imaging was only performed when there were symptoms or signs that were suspicious for VTE. The primary endpoint was the VTE incidence at 4 weeks postoperatively in cohort A. RESULTS: The postoperative incidence of VTE was 3.0% (n=12) in cohort A. Among the 12 patients, eight had distal calf vein thromboses and one had symptomatic thrombosis. Age ≥ 70 years (odds ratio [OR], 5.61), ≥ 2 comorbidities (OR, 13.42), and white blood cell counts of > 10,000/μL (OR, 17.43) were independent risk factors for postoperative VTE (p < 0.05). In cohort B, there was one case of VTE (0.7%). CONCLUSION: The postoperative incidence of VTE, which included asymptomatic cases, was 3.0% in Korean CRC patients who did not receive pharmacologic thromboprophylaxis. Perioperative pharmacologic thromboprophylaxis should be administered to Asian CRC patients on a risk-stratified basis.
Asia ; Asian Continental Ancestry Group ; Cohort Studies ; Colorectal Neoplasms* ; Colorectal Surgery ; Comorbidity ; Humans ; Incidence* ; Leukocyte Count ; Prospective Studies* ; Risk Factors ; Thrombosis ; Ultrasonography, Doppler ; Veins ; Venous Thromboembolism*

In the previous experiments, we reported that ethanol extract of Gastrodiae Rhizoma, the dried tuber of Gastrodia ElataBlume (Orchidaceae) increased pentobarbital-induced sleeping behaviors. These experiments were undertaken to know whether 4-hydroxybenzaldehyde (4-HBD), is one of the major compounds of Gastrodiae Rhizoma increases pentobarbital-induced sleeping behaviors and changes sleep architectures via activating GABA(A)-ergic systems in rodents. 4-HBD decreased locomotor activity in mice. 4-HBD increased total sleep time, and decreased of sleep onset by pentobarbital (28 mg/kg and 40 mg/kg). 4-HBD showed synergistic effects with muscimol (a GABA(A) receptor agonist), shortening sleep onset and enhancing sleep time on pentobarbital-induced sleeping behaviors. On the other hand, 4-HBD (200 mg/kg, p.o.) itself significantly inhibited the counts of sleep-wake cycles, and prolonged total sleep time and non-rapid eye movement (NREM) in rats. Moreover, 4-HBD increased intracellular Cl- levels in the primary cultured cerebellar cells. The protein levels of glutamic acid decarboxylase (GAD) and GABA(A) receptors subunits were over-expressed by 4-HBD. Consequently, these results demonstrate that 4-HBD increased NREM sleep as well as sleeping behaviors via the activation of GABA(A)-ergic systems in rodents.
Animals ; Ethanol ; Eye Movements* ; Gastrodia* ; Glutamate Decarboxylase ; Hand ; Mice ; Motor Activity ; Muscimol ; Pentobarbital ; Rats ; Receptors, GABA-A ; Rodentia*

Poria cocos is a well-known traditional Chinese traditional medicine (TCM) that grows around roots of pine trees in China, Korea, Japan, and North America. Poria cocos has been used in Asian countries to treat insomnia as either a single herb or part of an herbal formula. In a previous experiment, pachymic acid (PA), an active constituent of Poria cocos ethanol extract (PCE), increased pentobarbital-induced sleeping behaviors. The aim of this experiment was to evaluate whether or not PCE and PA modulate sleep architectures in rats as well as whether or not their effects are mediated through GABA(A)-ergic transmission. PCE and PA were orally administered to individual rats 7 days after surgical implantation of a transmitter, and sleep architectures were recorded by Telemetric Cortical encephalogram (EEG) upon oral administration of test drugs. PCE and PA increased total sleep time and non-rapid eye movement (NREM) sleep as well as reduced numbers of sleep/wake cycles recorded by EEG. Furthermore, PCE increased intracellular chloride levels, GAD65/67 protein levels, and alpha-, beta-, and gamma-subunits of GABA(A) receptors in primary cultured hypothalamic neuronal cells. These data suggest that PCE modulates sleep architectures via activation of GABA(A)-ergic systems. Further, as PA is an active component of PCE, they may have the same pharmacological effects.
Administration, Oral ; Animals ; Asian Continental Ancestry Group ; China ; Cocos* ; Electroencephalography ; Ethanol* ; Eye Movements ; Glutamate Decarboxylase ; Humans ; Japan ; Korea ; Medicine, Chinese Traditional ; Neurons ; North America ; Pinus ; Poria* ; Rats* ; Receptors, GABA-A ; Sleep Initiation and Maintenance Disorders

To examine the effect of obesity on volume perception according to size and color of rice bowl, we divided female college students into a normal weight group (<30% fat mass, n=100) and obese group (> or =30% fat mass, n=83) and then measured perceived volume of rice bowls of various sizes (general size; 350 ml vs. small size; 188 ml) and color (yellow, white, blue, and black) containing the same amount of cooked white rice (210 g). Normal weight group perceived that the general rice bowl contained significantly more cooked white rice compared to the small rice bowl. In contrast, the obese group perceived that the general rice bowl contained significantly less cooked white rice than the small rice bowl. The estimated variance in perceived volume of both bowls was significantly bigger in the obese group compared to the normal group. There were no differences in perceived volume among any of the subjects (both normal and obese groups) according to rice bowl color. However, the estimated variance in perceived volume in the obese group was significantly larger than that in the normal group for all of the rice bowls. In conclusion, rice bowl size and color might affect volume perception, and volume perception in obese people may be different from that of normal weight people.
Female ; Humans ; Obesity

This study was carried out to examine the proportion of fatty acids and contents of trans fatty acid in commercial processed foods in Jeon-Buk area. Contents of trans fatty acid in bakery products ranged from 0.2% to 1.0% per 100 g food. Especially garlic bread and pastry contained the highest amount. Popcorns contained trans fatty acid from 0.0% to 13.4%. Among them, instant popcorns for microwave contained the highest amount, while trans fatty acid was hardly detected in popcorns for theater. And trans fatty acid detected in popcorns was mostly in the form of 18 : 1 trans. The content of trans fatty acid in pizza was nearly 0.2%. Amounts of saturated fatty acid and unsaturated fatty acid were similar between each type of pizza and frozen pizza. Fritters such as fried chickens and vegetables contained trans fatty acid less than 0.2% per 100 g food.
Bread ; Chickens ; Fatty Acids ; Garlic ; Microwaves ; Vegetables

BACKGROUND AND OBJECTIVES: Vestibular evoked myogenic potentials (VEMP) have become a good diagnostic tool to evaluate the integrity of the vestibulocollic reflex. To investigate the standard recording of VEMP response in normal hearing subjects, the authors studied the effects of test positions and different acoustic stimulations on the VEMP. SUBJECTS AND METHOD: We performed VEMP on both ears of thirty normal hearing volunteers. Three acoustic stimulations (clicks and 500 Hz and 1,000 Hz short tone bursts) and four test positions were presented alternately to evoke VEMP. The latencies of peak p13 and n23, p13n23 interpeak latency (IPL) and amplitude were measured by EMG equipment and compared by statistical program. We also made up questions for the compliance of the test positions. RESULTS: The effects of test positions p13 latency had no significant difference on all test positions except between test position 2 and 4, n23 latency and p13n23 IPL had shortest waveform on test position 2, p13n23 amplitude had the largest waveform in test position 4. Acoustic stimulations on all test positions were influenced that clicks had shorter waveform about 2-3 ms than STBs on p13 latency and n23 latency, STBs had larger waveform than clicks on p13n23 amplitude. And the compliance of the test positions exhibited highest comfort in test position 1. CONCLUSION: Test position 1 had higher VEMP response rates and compliance, 500 Hz STB had a largest p13n23 amplitude. Therefore we recommend that the ideal conditions were position 1 and 500 Hz STB for acoustic stimulations to evoke VEMP.
Acoustics* ; Compliance ; Ear ; Hearing ; Reflex ; Vestibular Evoked Myogenic Potentials* ; Volunteers

VACTERL association is a disease with multiple congenital anomalies of the vertebrae, anus, cardia, tracheoesophageal(TE) fistula, renal and limb. This disease is derived from VATER anomaly, accompanied by cardiac and limb anomalies. We experienced a case of a 1-day-old boy with anal atresia, who represented multiple anomalies during hospital course. The multiple anomalies were hemivertebra, anal atresia, complex heart disease(coarctation of aorta, secundum aterial septal defect, patent ductus arteriosus), horseshoe kidney, tracheal stenosis, tracheal bronchus and left upper lung agenesis. Because both trachea and esophagus arise from fetal foregut, tracheal or pulmonary anomalies may be developed in VACTERL association instead of TE fistula. VACTERL association with tracheal anomalies, such as tracheal stenosis and tracheal bronchus or pulmonary agenesis, have been reported in foreign scientific society reports. But a case of VACTERL association with both tracheal bronchus and pulmonary agenesis has not reported yet. So we report this case with a brief review of related literature and suggest the consideration of possibility of tracheal or pulmonary anomaly in VACTERL association without TE fistula.
Anal Canal ; Anus, Imperforate ; Aorta ; Bronchi* ; Cardia ; Esophagus ; Extremities ; Fistula ; Heart ; Humans ; Kidney ; Lung ; Male ; Societies, Scientific ; Spine ; Trachea ; Tracheal Stenosis* ; Tracheoesophageal Fistula*

Radiation-induced epithelial proliferation in the urinary bladder mimicking urothelial carcinoma has received only a little attention in the literature. Herein, we describe two cases of radiation-induced epithelial proliferative changes, which mimicked invasive urothelial carcinoma. Cystoscopy revealed bullous or edematous mucosal changes with multiple hemorrhagic foci. Microscopically, we observed inverted epithelial proliferation, forming nests and cords extending into the lamina propria. The epithelial cells in these nests and cords exhibited enlarged, hyperchromatic and pleomorphic nuclei, closely mimicking the infiltrative growth of urothelial carcinoma. However, the presence of radiation-induced changes was validated by the observation of abundant vacuolated cytoplasm, normal or slightly increased nuclear to cytoplasmic ratios, the absence of mitotic activity, dilated blood vessels containing frequent fibrin thrombi, scattered atypical fibroblasts, and the patients' previous history of radiation treatment. Radiation-induced changes should be always included in differential diagnoses of proliferative epithelial lesions in the urinary bladder and a pertinent clinical history of radiotherapy should be searched.
Blood Vessels ; Cystitis ; Cystoscopy ; Cytoplasm ; Diagnosis, Differential ; Epithelial Cells ; Fibrin ; Fibroblasts ; Mucous Membrane ; Radiation Injuries ; Radiotherapy ; Urinary Bladder*

PURPOSE: Dental CT software program can provide reformatted cross-sectional and panoramic images that cannot be obtained with conventional axial & direct coronal CT scan. The purpose of this study is to describe the method of the technique and to identify the precise anatomy of jaw. MATERIALS AND METHODS:We evaluated 13 mandibles & 7 maxillae of 15 subjects without bony disease who were being considered for endosseous dental implants. Reformatted images obtained by the use of bone algorithm performed on GE HiSpeed Advantage CT scanner were retrospectively reviewed for detailed anatomy of RESULTS: Anatomy related to neurovascular bundle(mandibular foramen, inferior alveolar canal, mental foramen, canal for incisive artery, nutrient canal, lingual foramen and mylohyoid groove), muscular insertion(mylohyoid line, superior & inferior genial tubercle and digastric fossa) and other anatomy(submandibular fossa, sublingual fossa, contour of alveolar process, oblique line, retromolar fossa, temporal crest & retromolar triangle) were well delineated in mandible. In maxilla, anatomy related to neurovascular bundle(greater palatine foramen & groove, nasopalatine canal and incisive foramen) and other anatomy(alveolar process, maxillary sinus & nasal fossa) were also well delineated. CONCLUSION: Reformatted images using dental CT software program provided excellent delineation of the jaw anatomy. Therefore, dental CT noftware program can play an important role in the preoperative assessment of mandible and maxilla for dental implants and other surgical conditions.
Alveolar Process ; Arteries ; Dental Implants ; Haversian System ; Jaw* ; Mandible ; Maxilla ; Maxillary Sinus ; Retrospective Studies ; Tomography, X-Ray Computed