Background: With the aging population and advancements in medical care worldwide, the number of older patients with end-stage kidney disease continues to rise. This study aimed to identify factors associated with osteoporosis and osteopenia in older patients undergoing incident hemodialysis and assess their impact on mortality. Methods: We analyzed a large multicenter retrospective cohort of patients aged ≥70 years undergoing incident hemodialysis to identify factors associated with osteoporosis using logistic regression analysis and to assess the association of death with osteoporosis and osteopenia using Cox multivariable analysis. Results: Among 710 patients, 39.0% and 19.6% had osteoporosis and osteopenia, respectively. Osteoporosis was significantly associated with female sex, a history of fractures, and the absence of phosphate binder use. During a median follow-up of 36.8 months, 348 participants (58.8%) died. Mortality rates were the highest in the osteoporosis group (79.8%), followed by the osteopenia (77.2%) and normal bone mineral density (BMD) groups (35.2%). Cox regression analysis revealed that even after adjusting for covariates, the osteoporosis group was significantly associated with a higher mortality risk than the normal BMD group. Osteoporosis at the start of hemodialysis was significantly associated with higher mortality. Conclusion We should consider the importance of bone health in patients undergoing incident hemodialysis and pay attention to the use of phosphate binders and fracture prevention.

The aim of this retrospective study was to investigate etiology, clinical features, and treatment modalities of the mandibular condyle fracture in children and young adolescents. This study was conducted based on medical records and radiographic examinations of 44 pediatric patients. Patients received treatment under diagnosis of mandibular condylar fracture. They were divided into 4 groups according to their age. The involvement of condyle in the mandible fracture occurred in higher percentage in younger age groups. Falling was the most common etiologic factor in all age group, especially in children with age under 7. Condyle head was the most frequent site of fracture in age group of 4-7 whereas fracture tends to occur in lower condylar areas in older groups. In 54.5% of the mandibular condyle fracture, symphysis fracture was accompanied. Teeth injury occurred in higher incidency when condyle fracture accompanied symphysis fracture. Conservative treatments were applied to 43 out of 44 patients.

PURPOSE: In this study factors affecting job satisfaction and turnover intention of nurses were explored in the context of organizational culture, self-leadership, and empowerment. METHODS: Participants were 286 nurses drawn from 3 general hospitals. Data were analyzed using t-test, one-way ANOVA, Pearson correlation, and hierarchial multiple regression with the SPSS/WIN 18.0 program. RESULTS: Significant differences in job satisfaction and turnover intention were found according to organizational culture types. Significant positive correlations were found between self-leadership, empowerment, task oriented organizational culture, relationship oriented organizational culture, innovation oriented organizational culture and job satisfaction. On the other hand, significant negative relationships were found between empowerment, relationship oriented organizational culture, innovation oriented organizational culture and turnover intention. The factors that enhance job satisfaction were found to be higher innovation-oriented organizational culture. Lower turnover intention was shown to be positively associated with relationship- or innovation oriented organization culture. CONCLUSION: Innovation oriented organizational culture is needed in order to raise job satisfaction and reduce turnover intention of nurses.
Hand ; Hospitals, General* ; Intention* ; Job Satisfaction* ; Organizational Culture* ; Power (Psychology)*

Cytochrome P450 4A11 (CYP4A11) is a fatty acid hydroxylase enzyme expressed in human liver. It catalyzes not only the hydroxylation of saturated and unsaturated fatty acids, but the conversion of arachidonic acid to 20-hydroxyeicosatetraenoic acid (20-HETE), a regulator of blood pressure. In this study, we performed a directed evolution analysis of CYP4A11 using the luminogenic assay system. A random mutant library of CYP4A11, in which mutations were made throughout the entire coding region, was screened with luciferase activity to detect the demethylation of luciferin-4A (2-[6-methoxyquinolin-2-yl]-4,5-dihydrothiazole-4-carboxylic acid) of CYP4A11 mutants in Escherichia coli. Consecutive rounds of random mutagenesis and screening yielded three improved CYP4A11 mutants, CP2600 (A24T/T263A), CP2601 (T263A), and CP2616 (A24T/T263A/V430E) with ~3-fold increase in whole cells and >10-fold increase in purified proteins on the luminescence assay. However, the steady state kinetic analysis for lauric acid hydroxylation showed the significant reductions in enzymatic activities in all three mutants. A mutant, CP2600, showed a 51% decrease in catalytic efficiency (k cat/K m) for lauric acid hydroxylation mainly due to an increase in K m. CP2601 and CP2616 showed much greater reductions (>75%) in the catalytic efficiency due to both a decrease in k cat and an increase in K m. These decreased catalytic activities of CP2601 and CP2616 can be partially attributed to the changes in substrate affinities. These results suggest that the enzymatic activities of CYP4A11 mutants selected from directed evolution using a luminogenic P450 substrate may not demonstrate a direct correlation with the hydroxylation activities of lauric acid.
Animals ; Arachidonic Acid ; Blood Pressure ; Cats ; Clinical Coding ; Cytochrome P-450 Enzyme System ; Escherichia coli ; Fatty Acids, Unsaturated ; Humans* ; Hydroxylation ; Liver ; Luciferases ; Luminescence ; Mass Screening ; Mutagenesis

BACKGROUND: Spotted fever group rickettsiosis occurs worldwide and includes various causative organisms depending on the region and clinical features. In Korea, previous studies have shown that several kinds of spotted fever rickettsiae have been identified in ticks, and in stored sera obtained from febrile patients. Previously, it was difficult to correlate the results of serologic or molecular biologic tests with the clinical or epidemiological features of this disease in humans. In 2004, the first Korean patient with Japanese spotted fever (JSF) was identified on Mueui Island, Incheon, Korea. To estimate the prevalence of JSF and to compare the incidence of JSF with those of other infectious diseases endemic to Korea, we performed a serosurvey of Japanese spotted fever and other rickettsiosis (scrub typhus and murine typhus), hemorrhagic fever with renal syndrome and leptospirosis on the island where the patient had been living. MATERIALS AND METHODS: In October 2004, we performed a seroprevalence survey of Mueui Island where nearly 300 persons resided. There were 91 persons who participated in the survey and answered the questionnaire. The participants included 30 healthy subjects receiving a check up at the Health Promotion Center at Inha University Hospital, and 30 patients with rheumatoid factor as control groups for the serologic tests. RESULTS: Of the 91 residents, only one person showed a positive reaction to R. japonica at a titer of 1:80. IgG antibodies against O. tsutsugamushi were positive at a titer of 1:32 in 3 persons, and those against R. typhi were at 1:32 in 1 person and at 1:64 in 2 persons. Serum IgG antibodies to Hantan virus were positive at a dilution of 1:64 in 2 persons and those to leptospira were negative. All 30 healthy persons and 30 patients with rheumatoid factor in the control group showed negative results in 1:40 diluted sera. CONCLUSION: This study demonstrates that the seroprevalence of R. japonica is not as high in Korea as it is in Japan. Further studies should be performed in a large number of patients, including residents of other islands and the Korean peninsula.
Antibodies ; Asian Continental Ancestry Group* ; Communicable Diseases ; Fever* ; Health Promotion ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Immunoglobulin G ; Incheon ; Incidence ; Islands ; Japan ; Korea ; Leptospira ; Leptospirosis ; Prevalence ; Rheumatoid Factor ; Rickettsia* ; Scrub Typhus ; Seroepidemiologic Studies* ; Serologic Tests ; Ticks ; Typhus, Endemic Flea-Borne ; Typhus, Epidemic Louse-Borne ; Surveys and Questionnaires

BACKGROUND: Spotted fever group rickettsiosis occurs worldwide and includes various causative organisms depending on the region and clinical features. In Korea, previous studies have shown that several kinds of spotted fever rickettsiae have been identified in ticks, and in stored sera obtained from febrile patients. Previously, it was difficult to correlate the results of serologic or molecular biologic tests with the clinical or epidemiological features of this disease in humans. In 2004, the first Korean patient with Japanese spotted fever (JSF) was identified on Mueui Island, Incheon, Korea. To estimate the prevalence of JSF and to compare the incidence of JSF with those of other infectious diseases endemic to Korea, we performed a serosurvey of Japanese spotted fever and other rickettsiosis (scrub typhus and murine typhus), hemorrhagic fever with renal syndrome and leptospirosis on the island where the patient had been living. MATERIALS AND METHODS: In October 2004, we performed a seroprevalence survey of Mueui Island where nearly 300 persons resided. There were 91 persons who participated in the survey and answered the questionnaire. The participants included 30 healthy subjects receiving a check up at the Health Promotion Center at Inha University Hospital, and 30 patients with rheumatoid factor as control groups for the serologic tests. RESULTS: Of the 91 residents, only one person showed a positive reaction to R. japonica at a titer of 1:80. IgG antibodies against O. tsutsugamushi were positive at a titer of 1:32 in 3 persons, and those against R. typhi were at 1:32 in 1 person and at 1:64 in 2 persons. Serum IgG antibodies to Hantan virus were positive at a dilution of 1:64 in 2 persons and those to leptospira were negative. All 30 healthy persons and 30 patients with rheumatoid factor in the control group showed negative results in 1:40 diluted sera. CONCLUSION: This study demonstrates that the seroprevalence of R. japonica is not as high in Korea as it is in Japan. Further studies should be performed in a large number of patients, including residents of other islands and the Korean peninsula.
Antibodies ; Asian Continental Ancestry Group* ; Communicable Diseases ; Fever* ; Health Promotion ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Immunoglobulin G ; Incheon ; Incidence ; Islands ; Japan ; Korea ; Leptospira ; Leptospirosis ; Prevalence ; Rheumatoid Factor ; Rickettsia* ; Scrub Typhus ; Seroepidemiologic Studies* ; Serologic Tests ; Ticks ; Typhus, Endemic Flea-Borne ; Typhus, Epidemic Louse-Borne ; Surveys and Questionnaires