Background: Despite medical advancements in neonatal survival rates, many children have poor neurological outcomes. Because the law in Korea restricts the withdrawal of lifesustaining treatment to only cases of imminent death, treatment discontinuation may not be an option, even in patients with poor neurological prognosis. This study investigated the opinions of the general population and clinicians regarding life-sustaining treatment withdrawal in such cases using hypothetical scenarios. Methods: We conducted a cross-sectional study on the general population and clinicians using a web-based questionnaire. The sample of the general population from an online panel comprised 500 individuals aged 20–69 years selected by quota sampling. The clinician sample comprised 200 clinicians from a tertiary university hospital. We created hypothetical vignettes and questionnaire items to assess attitudes regarding mechanical ventilation withdrawal for an infant at risk of poor neurological prognosis due to birth asphyxia at 2 months and 3 years after the incidence. Results: Overall, 73% of the general population and 74% of clinicians had positive attitudes toward mechanical ventilator withdrawal at 2 months after birth asphyxia. The proportion of positive attitudes toward mechanical ventilator withdrawal was increased in the general population (84%, P < 0.001) and clinicians (80.5%, P = 0.02) at 3 years after birth asphyxia.Religion, spirituality, the presence of a person with a disability in the household, and household income were associated with the attitudes of the general population. In the multivariable logistic regression analysis of the general population, respondents living with a person with a disability or having a disability were more likely to find the withdrawal of the ventilator at 2 months and 3 years after birth asphyxia not permissible. Regarding religion, respondents who identified as Christians were more likely to find the ventilator withdrawal at 2 months after birth asphyxia unacceptable. Conclusion The general population and clinicians shared the perspective that the decision to withdraw life-sustaining treatment in infants with a poor neurological prognosis should be considered before the end of life. A societal discussion about making decisions centered around the best interest of pediatric patients is warranted.

Objective: The number of patients suffering from dysphagia is increasing in line with societal aging. However, preparing dysphagia diets at home or in welfare facilities is challenging due to the lack of commercially specifically designed products. The thickening agents used to prepare dysphagia meals can be difficult due to changes in viscosity and homogenization. Therefore, this study was performed to prepare dysphagia meals using commercially available foods following the classification system outlined by the International Dysphagia Diet Standardization Initiative (IDDSI). Methods: Commercial foods were categorized as main dishes, side dishes, and snacks. Selected foods were ground or minced, and 1-3 g of thickening agent was added. Following the IDDSI framework, fork flowability, spoon tilt, and gravity flow tests were conducted using a syringe, and based on these evaluations, texture-modified foods were classified as general, minced, ground, or liquid foods. Results: Commercial foods used in the experiment could be used in IDDSI Level 2-7 dysphagia diets after adjusting their structures. Food size and viscosities were appropriately controlled, and an usage manual was developed. Conclusion This study successfully demonstrated the easy incorporation of commercial food products into the dysphagia diets for personal care and welfare facilities. By adopting the described approach, dysphagia patients could be provided various meal options with improved service. In addition, this study suggests possibilities for developing and producing diverse products designed specifically for dysphagia patients.

OBJECTIVES: We estimated the population prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including unreported infections, through a Korea Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SEROSMART) in 258 communities throughout Korea. METHODS: In August 2022, a survey was conducted among 10,000 household members aged 5 years and older, in households selected through two stage probability random sampling. During face-to-face household interviews, participants self-reported their health status, COVID-19 diagnosis and vaccination history, and general characteristics. Subsequently, participants visited a community health center or medical clinic for blood sampling. Blood samples were analyzed for the presence of antibodies to spike proteins (anti-S) and antibodies to nucleocapsid proteins (anti-N) SARS-CoV-2 proteins using an electrochemiluminescence immunoassay. To estimate the population prevalence, the PROC SURVEYMEANS statistical procedure was employed, with weighting to reflect demographic data from July 2022. RESULTS: In total, 9,945 individuals from 5,041 households were surveyed across 258 communities, representing all basic local governments in Korea. The overall population-adjusted prevalence rates of anti-S and anti-N were 97.6% and 57.1%, respectively. Since the Korea Disease Control and Prevention Agency has reported a cumulative incidence of confirmed cases of 37.8% through July 31, 2022, the proportion of unreported infections among all COVID-19 infection was suggested to be 33.9%. CONCLUSIONS The K-SEROSMART represents the first nationwide, community-based seroepidemiologic survey of COVID-19, confirming that most individuals possess antibodies to SARS-CoV-2 and that a significant number of unreported cases existed. Furthermore, this study lays the foundation for a surveillance system to continuously monitor transmission at the community level and the response to COVID-19.

PURPOSE: Traffic accidents are increasing due to the development and increment of transportation. Previous studies on analysis of the correlation between environmental factors and traffic accidents have rarely been reported. The purpose of this study is to analyze the correlation between rainfall and traffic accidents including accident mechanism, incidence, and trauma severity of patients. METHODS: A retrospective review was conducted in 851 trauma patients who visited the emergency department (ED) after a traffic accident from January 2013 to December 2013; 248 patients due to a traffic accident when it was raining, and 603 patients when it was not raining. Demographic data, clinical data, and meteorological data (rainfall, daily mean air temperature, daily mean wind speed) in Busan were investigated. RESULTS: The incidence of traffic accidents was one-second and the injury severity score of patients was two points higher on rainy days. In addition, the length of hospital stay was three days longer (p=0.037), and the prognosis was poor in the rain group. Comparison of severe injury sustained over rain, injury time, and accident mechanism showed approximately a 3-fold odds increased rate of severe injury on rainy days (OR 2.55, 95% CI: 1.11-5.83, p=0.004) and a seven-fold odds increased rate of pedestrian traffic accidents (OR 7.26, 95% CI: 3.52-9.26, p<0.001) compared with car traffic accidents. In addition, a four-fold increased odds of night time (OR 3.79, 95% CI: 1.98-7.25, p<0.001) compared with day time accidents on rainy days. CONCLUSION: The incidence of traffic accidents and injury severity of patients increased on rainy days. Therefore, we suggest expansion of the scope of the emergency and trauma team activation for proper treatment on rainy days.
Accidents, Traffic* ; Busan* ; Emergencies ; Emergency Service, Hospital ; Humans ; Incidence ; Injury Severity Score ; Length of Stay ; Prognosis ; Rain ; Retrospective Studies ; Transportation ; Wind

BACKGROUND: The aims of this study were to compare several DNA extraction methods and 16S rDNA primers and to evaluate the clinical utility of broad-range PCR in continuous ambulatory peritoneal dialysis (CAPD) culture fluids. METHODS: Six type strains were used as model organisms in dilutions from 10(8) to 100 colony-forming units (CFU)/mL for the evaluation of 5 DNA extraction methods and 5 PCR primer pairs. Broad-range PCR was applied to 100 CAPD culture fluids, and the results were compared with conventional culture results. RESULTS: There were some differences between the various DNA extraction methods and primer sets with regard to the detection limits. The InstaGene Matrix (Bio-Rad Laboratories, USA) and Exgene Clinic SV kits (GeneAll Biotechnology Co. Ltd, Korea) seem to have higher sensitivities than the others. The results of broad-range PCR were concordant with the results from culture in 97% of all cases (97/100). Two culture-positive cases that were broad-range PCR-negative were identified as Candida albicans, and 1 PCR-positive but culture-negative sample was identified as Bacillus circulans by sequencing. Two samples among 54 broad-range PCR-positive products could not be sequenced. CONCLUSIONS: There were differences in the analytical sensitivity of various DNA extraction methods and primers for broad-range PCR. The broad-range PCR assay can be used to detect bacterial pathogens in CAPD culture fluid as a supplement to culture methods.
Bacillus/genetics/isolation & purification ; Bacteria/genetics/*isolation & purification ; Candida albicans/genetics/isolation & purification ; DNA Primers/genetics ; DNA, Bacterial/*analysis/isolation & purification ; *Genetic Techniques/standards ; Humans ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis/*microbiology ; Polymerase Chain Reaction ; Reagent Kits, Diagnostic ; Sequence Analysis, DNA

BACKGROUND: We investigated the prevalence of plasmid-mediated quinolone resistance and its association with extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase in Enterobacteriaceae. METHODS: A total of 347 non-duplicated isolates of Enterobacteriaceae were collected between August and October 2006 from 2 hospitals. Qnr determinant screening was conducted using PCR amplification, and all positive results were confirmed by direct sequencing. Qnr-positive strains were determined on the basis of the presence of ESBL and AmpC beta-lactamase genes. RESULTS: The qnr gene was detected in 47 of 347 clinical Enterobacteriaceae isolates. Among the 47 qnr-positive strains, Klebsiella pneumoniae (N=29) was the most common, followed by Escherichia coli (N=6), Enterobacter cloacae (N=6), Citrobacter freundii (N=5), and Enterobacter aerogenes (N=1). These isolates were identified as qnrA1 (N=6), 8 qnrB subtypes (N=40), and qnrS1 (N=1). At least 1 ESBL was detected in 38 of the 47 qnr-positive strains. Qnr-positive strains also showed high positive rates of ESBL or AmpC beta-lactamase, such as TEM, SHV, CTX-M, and DHA. DHA-1 was detected in 23 of 47 qnr-positive strains, and this was co-produced with 1 qnrA1 and 22 qnrB4. Strains harboring MIR-1T and CMY were also detected among the qnr-positive strains. Antimicrobial-resistance rates of qnr-positive strains to ciprofloxacin, levofloxacin, norfloxacin, nalidixic acid, and moxifloxacin were 51.1%, 46.8%, 46.8%, 74.5%, and 53.2%, respectively. CONCLUSIONS: The qnr genes were highly prevalent in Enterobacteriaceae, primarily the qnrB subtypes. They were closely associated with EBSL and AmpC beta-lactamase.
Anti-Bacterial Agents/*pharmacology ; Bacterial Proteins/biosynthesis/*genetics ; DNA, Bacterial/chemistry/genetics ; Drug Resistance, Bacterial/*genetics ; Enterobacteriaceae/enzymology/*genetics/isolation & purification ; Enterobacteriaceae Infections/microbiology ; *Genetic Variation ; Hospitals, University ; Humans ; Microbial Sensitivity Tests ; Plasmids/genetics/*metabolism ; Quinolones/*pharmacology ; beta-Lactamases/biosynthesis/genetics

BACKGROUND/AIMS: Hypoxia-inducible factor-1alpha (HIF-1alpha) is a central transcriptional factor involved in the cellular responses related to various aspects of cancer biology, including proliferation, survival, and angiogenesis, and the metabolism of the extracellular matrix in hypoxia. This study evaluated whether adenovirus-mediated small hairpin RNA (shRNA) against HIF-1alpha (shHIF-1alpha) inhibits cell proliferation and angiogenesis in hepatocellular carcinoma (HCC) cell lines. METHODS: Knockdown of HIF-1alpha expression was constructed by adenovirus-mediated RNA interference tools, and HCC cell lines infected with shHIF-1alpha coding virus were cultured under a hypoxia condition (1% O2) for 24 hours. Following infection, the expression levels of HIF-1alpha, angiogenesis factors, and matrix metalloproteinase (MMP) were examined using Western blotting. Cell proliferation and angiogenesis were measured by a cell proliferation assay (MTT assay) and an angiogenesis-related assay (invasion and tube-formation assay), respectively. RESULTS: Adenovirus mediated inhibition of HIF-1alpha induced suppression of tumor growth in HCC cell lines. It also down-regulated the expression of angiogenesis factor and MMP proteins. Angiogenesis as well as mobility of vascular cells to tumor was suppressed by adenovirus-mediated shHIF-1alpha-infected groups in human umbilical vein endothelial cells (HUVECs). CONCLUSIONS: These data suggest that adenovirus-mediated inhibition of HIF-1alpha inhibits the invasion, tube formation, and cell growth in HUVECs and HCC cells.
Adenoviridae/genetics ; Carcinoma, Hepatocellular/*blood supply/metabolism/therapy ; Cell Line, Tumor ; Cell Proliferation ; Endothelial Cells/metabolism ; Gene Knockdown Techniques ; Genetic Vectors ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit/*antagonists & ; Liver Neoplasms/*blood supply/metabolism/therapy ; Matrix Metalloproteinases/metabolism ; Neovascularization, Pathologic/genetics/metabolism/*therapy ; RNA Interference ; RNA, Small Interfering/metabolism

PURPOSE: The study aimed to explore the health consequences that women experienced after miscarriage and the factors related to them. METHODS: A convenience sample consisting of 102 women who had miscarried within 2 years was used. Women were recruited from hospitals and enterprises in Seoul and Gyeong-Gi Province. Participants completed a self-administered questionnaire containing a physical and psychological symptoms checklist developed for this study. RESULTS: More than 40% of the miscarriages occurred after 9 weeks of pregnancy and 35% of women were found to have had a previous miscarriage prior to this study. Psychological symptoms were more prevalent and prolonged than the physical symptoms, furthermore, the frequencies of the symptoms experiencedwere not consistent with the duration of symptoms. Employed women and women with early miscarriages complained of more physical symptoms; however, psychological symptoms were not different according to women's characteristics. Employment was a significant factor affecting physical symptoms. CONCLUSION: Health care professionals need to inform and educate women and the family of the potential health changes during the recovery after the miscarriage. Health consequences due to miscarriages also need to be incorporated in women's reproductive health care. Nursing care should consider factors of maternal age, employment status, and obstetrical conditions upon the apparent social changes.
Abortion, Spontaneous ; Checklist ; Delivery of Health Care ; Employment ; Female ; Humans ; Maternal Age ; Nursing Care ; Pregnancy ; Surveys and Questionnaires ; Reproductive Health ; Social Change

BACKGROUND: There is no guideline for the appropriate wavelength at which to measure the optical density (OD) value in broth microdilution antifungal susceptibility testing, although a spectrophotometric reading method is commonly used. The present study aimed to analyze the difference in the OD values over the range of visible light and to ascertain the optimal wavelength for the spectrophotometric method of microdilution testing. METHODS: We measured the OD of background blank controls of broth medium, antifungal agents, and inocula of five type strains using a Synergy HT multi-detection microplate reader at 5-nm intervals from 380 nm to 760 nm. We also estimated the OD differences between the 50% of growth control and blank control. RESULTS: The OD of the blank control showed a parabola shape with two peaks and steadily decreased at longer wavelengths. The curves of the antifungal agent were similar to those of blank controls, and the influence of each antifungal agent on the OD was minimal. For the difference in OD between 50% of growth control and the blank control, the curve was the opposite of the blank control, and the OD increased steadily at the wavelengths above 600 nm. CONCLUSIONS: The range between 600 nm and 700 nm was the optimal wavelength for broth microdilution antifungal susceptibility testing, although any wavelength within the visible light spectrum can be used.
Antifungal Agents/*chemistry ; Azoles/*chemistry ; Culture Media/*chemistry ; Flucytosine/*chemistry ; Microbial Sensitivity Tests ; Spectrophotometry/*methods

A medullary carcinoma of the breast is an uncommon breast cancer subtype, but has a fair prognosis. The histopathological criteria for a medullary carcinoma were delineated by Ridolfi et al. in 1977, and most pathologists use these criteria. The authors experienced a huge carcinoma of the breast, which was diagnosed as an atypical medullary carcinoma. A 47-year old female visited our clinic due to a breast mass of six months duration. The mass was 16 cm in size and exophytic in the left lower breast. There had been necrosis, with a foul odor in most of the mass. A large fixed axillary lymph node was noted, but there was no evidence of distant metastasis. A radical mastectomy was performed due to invasion of the pectoralis major. On pathological examination, the tumor was diagnosed as an atypical medullary carcinoma.
Breast ; Breast Neoplasms* ; Carcinoma, Medullary ; Female ; Humans ; Lymph Nodes ; Mastectomy, Radical ; Necrosis ; Neoplasm Metastasis ; Odors ; Prognosis