Background: Transfusion appropriateness is extremely important due to the growing concerns about the decrease in the supply of blood products and the increase in demand. Considerable time and effort are required to effectively collect and analyze large volumes of data. Therefore, we aimed to develop a transfusion appropriateness management program using the Tableau visual analytics platform, which allows intuitive visualization through various visualization options and interactive features and can quickly process large volumes of data. Methods: Using the transfusion prescription history and blood management and distribution history, we created a data mart comprising patient information, hospitalization history, inpatient/outpatient prescriptions, test results, records, and surgical information. Based on this we developed visualization analysis content for monitoring transfusion appropriateness.We automated the periodic aggregation of the data mart into an analysis database and connected it to Tableau. Results: We developed Transfusion Appropriateness Management (TAM), a program for managing transfusion appropriateness linked to Tableau, after analyzing transfusion-related data and metadata extracted from the Daejeon Eulji Medical Center's order communication system/electronic medical record (OCS/EMR) system. Detailed filters were applied to allow users to intuitively view the desired data according to their criteria. Data were visualized in various forms, such as bar graphs, heat maps, and box plots based on filtering criteria. Conclusion The development of the Transfusion Appropriateness Management program at the Daejeon Eulji Medical Center is expected to effectively reduce inappropriate transfusions in clinical settings and enhance patient safety within the hospital by swiftly and conveniently visualizing vast amounts of data.

Background: Long commuting times have a negative impact on mental health. However, few studies have explored the relationship between commuting time and well-being based on urbanization by region. Our study examines this relationship as well as the effect of regional differences on Korean workers. Methods: We used data from the sixth Korean Working Conditions Survey. Commuting time and occupational factors were assessed using a questionnaire, and subjective well-being was assessed using the World Health Organization-5 Well-Being Index. Regions were divided into the cities and the provinces based on Korea’s administrative divisions. Logistic regression analysis was performed to investigate the association between commuting time and wellbeing. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for well-being were estimated, using participants commuting time of < 20 minutes as a reference group. Results: The total number of workers was 29,458 (13,855 men, 15,603 women). We found higher aORs for low well-being among workers with long commuting times (aOR, 1.23; 95% CI, 1.11–1.36 and aOR, 1.28; 95% CI, 1.16–1.42 for 60–79 and ≥ 80 minutes, respectively). When stratified by sex and region, higher aORs for low well-being were found only in the workers who lived in cities. Conclusion Long commuting time was negatively associated with well-being in Korean wage workers living in the cities. Policies for reducing commuting time should be discussed to address the mental health of workers, especially those living in metropolitan cities.

Behçet's disease is a systemic vasculitis of unknown etiology characterized by recurrent oral and genital ulcers and uveitis. The vascular involvement of Behçet's disease affects arteries, veins, and blood vessels of all sizes, and it can include venous or arterial thrombosis and arterial aneurysms. There are only a few reports of an aortic aneurysm invading a vertebral body in a patient with Behçet's disease. Here, we report the case of a 45-year-old man who was initially diagnosed with vertebral invasion of a mycotic aneurysm. He underwent vascular surgery and received empirical antibiotics, but all cultures were negative. However, he had persistent, recurrent deep vein thrombosis and elevated inflammatory markers. After reviewing the pathology, a final diagnosis of Behçet's disease was made. He was successfully treated with corticosteroids. This report presents a rare case of Behçet's disease mimicking vertebral invasion of a mycotic aneurysm.
Adrenal Cortex Hormones ; Aneurysm ; Aneurysm, Infected* ; Anti-Bacterial Agents ; Aortic Aneurysm ; Arteries ; Behcet Syndrome ; Blood Vessels ; Diagnosis ; Humans ; Middle Aged ; Osteomyelitis ; Pathology ; Systemic Vasculitis ; Thrombosis ; Ulcer ; Uveitis ; Veins ; Venous Thrombosis

BACKGROUND: Prospective studies on occupational stress and depression among Korean workers are scarce. This study aimed to investigate the causal relationship between changes in occupational stress and the presence of depression. METHODS: This study analyzed data from a survey conducted with workers in a large Korean company (2015–2016). Occupational stress was measured using the Korean Occupational Stress Scale, and depression was screened using the WHO-5 Well-being Index. The levels of occupational stress were grouped in quartiles based on subjects’ occupational stress scores in 2015, and changes in occupational stress were measured using the score changes between the 2015 and 2016 surveys. Subjects were divided into four groups according to the presence or absence of depression in 2015 and 2016: a non-depressed group whose mental health did not change, a non-depressed group whose mental health deteriorated, a depressed group that continued to be depressed, and a depressed group whose symptoms of depression were alleviated. Logistic regression analysis was used to calculate the odds ratios (ORs) and confidence intervals (CIs) of the subjects’ deterioration in mood or alleviation of depression by occupational stress levels and changes. RESULTS: The OR for developing depressive symptoms was 2.51 (95% CI 1.46–4.33) and 2.73 (95% CI 1.39–5.36) in the third and the fourth quartiles of occupational stress, respectively, compared to the first quartile. When the occupational stress score increased by 1 point, the OR for increasing depressive symptoms was 1.07 (95% CI 1.04–1.10). There was no significant difference in the alleviation of depressive symptoms between the groups by level of occupational stress. However, when the occupational stress score decreased by 1 point, the OR for alleviating depressive symptoms was 1.08 (95% CI 1.05–1.11). CONCLUSION: The results showed that increased occupational stress increased the presence of depressive symptoms, and that reduced occupational stress suppressed the development of depressive symptoms. More attention should be paid to stress management among workers.
Depression ; Logistic Models ; Longitudinal Studies ; Mental Health ; Odds Ratio ; Prospective Studies

BACKGROUND/AIMS: The aim of this study was to identify the profile of rare variants associated with Crohn's disease (CD) using whole exome sequencing (WES) analysis of Korean children with CD and to evaluate whether genetic profiles could provide information during medical decision making. METHODS: DNA samples from 18 control individuals and 22 patients with infantile, very-early and early onset CD of severe phenotype were used for WES. Genes were filtered using panels of inflammatory bowel disease (IBD)-associated genes and genes of primary immunodeficiency (PID) and monogenic IBD. RESULTS: Eighty-one IBD-associated variants and 35 variants in PID genes were revealed by WES. The most frequently occurring variants were carried by nine (41%) and four (18.2%) CD probands and were ATG16L2 (rs11235604) and IL17REL (rs142430606), respectively. Twenty-four IBD-associated variants and 10 PID variants were predicted to be deleterious and were identified in the heterozygous state. However, their functions were unknown with the exception of a novel p.Q111X variant in XIAP (X chromosome) of a male proband. CONCLUSIONS: The presence of many rare variants of unknown significance limits the clinical applicability of WES for individual CD patients. However, WES in children may be beneficial for distinguishing CD secondary to PID.
Asian Continental Ancestry Group/genetics ; Carrier Proteins/genetics ; Child ; Child, Preschool ; Crohn Disease/*genetics ; *Exome ; Female ; Genetic Predisposition to Disease ; *Genetic Variation ; Humans ; Immunologic Deficiency Syndromes/genetics ; Infant ; Male ; Phenotype ; Receptors, Interleukin-17/genetics ; Republic of Korea ; Sequence Analysis, DNA/*methods ; X-Linked Inhibitor of Apoptosis Protein/genetics

PURPOSE: Multiple chemical sensitivity (MCS) is a clinical syndrome representing multi-organ and psychological symptoms caused by chronic exposure to various chemicals in low concentrations. We evaluated the prevalence and related factors of MCS targeting Korean adults using the Quick Environmental Exposure and Sensitivity Inventory (QEESI(c)). METHODS: A total of 446 participants were recruited from Severance Hospital. Participants underwent a questionnaire interview including questions on sociodemographic factors, occupational and environmental factors, allergic diseases, and the QEESI(c). Among them, 379 participants completed the questionnaire and the QEESI(c). According to the QEESI(c) interpretation results, participants were divided into very suggestive (VS) group and less suggestive (LS) group. RESULTS: The estimated prevalence of MCS was higher in allergic patients than non-allergic participants (19.7% and 11.3%, respectively, P=0.04). In the multivariate logistic regression analysis, ages of 30-39 (OR, 2.94; 95% CI, 1.25-6.95) and those of 40-49 (OR, 2.51; 95% CI, 1.02-6.21) were significantly related to MCS compared to those aged less than 30 years. Female sex (OR, 2.16; 95% CI, 1.11-4.18), experience of dwelling in a new house (OR, 2.05; 95% CI, 1.04-4.03), and atopic dermatitis (OR, 1.95; 95% CI, 1.04-3.69) were also significantly related to MCS. However, only age of 30-39 in the allergic group was significant in the stratified analysis. CONCLUSIONS: The estimated prevalence of MCS was higher among allergic patients than non-allergic participants. People with experience of dwelling in a new house and atopic dermatitis were more at risk of being intolerant to chemicals. Further studies to provide the nationally representative prevalence data and clarify risk factors and mechanisms of MCS are required.
Adult* ; Dermatitis, Atopic ; Environmental Exposure ; Female ; Humans ; Logistic Models ; Multiple Chemical Sensitivity* ; Prevalence ; Risk Factors

Bronchiolitis obliterans organizing pneumonia (BOOP) is a clinicopathological syndrome associated with a variety of disease entities. The aim of this study was to review cases with initial diagnosis of BOOP applying uniform histopathologic criteria, and analyze the clinical characteristics of proven cases of BOOP including rapidly progressive form. A total of 81 cases, initially diagnosed as BOOP and with available tissue sections, was collected. Thirty six cases (44.4%) were excluded from the study, more than two thirds of which were given a revised diagnosis of interstitial pneumonitis/fibrosis other than BOOP. Thirty one patients were classified as idiopathic BOOP, 8 patients as secondary BOOP, and 6 patients as rapidly progressive BOOP. Open lung biopsy specimen from all six cases with lethal outcome showed more severe interstitial inflammation and septal fibrosis and/or alveolar exudate with a varying degree than those with good prognosis. There was no difference by the sexes. The two most frequent presenting symptoms were cough and dyspnea. Bilateral multifocal consolidation was a common radiological finding. More than 70% cases of idiopathic BOOP experienced clinical improvements. The diagnosis of BOOP is usually suggested by clinicoradiologic findings, but needs to be confirmed histopathologically, preferably through surgical open or video-assisted thoracoscopic biopsy.
Adult ; Blood Gas Analysis ; Bronchoalveolar Lavage ; Cryptogenic Organizing Pneumonia/drug therapy/pathology/*physiopathology ; Disease Progression ; Female ; Forced Expiratory Volume ; Humans ; Korea ; Male ; Middle Aged ; Treatment Outcome

Sarcoidosis, in general, has a low mortality rate. But cardiac sarcoidosis (CS) is a serious condition which may lead to death. Here, we report a rare case of CS that was treated by heart transplantation. A 47-year-old male had occasional syncopes and atypical chest pain. Ventricular tachycardia with right bundle branch block was noted by electrocardiogram. Multiple fixed myocardial perfusion defects in the interventricular septum and both the inferior-posterior ventricular walls were observed by thallium scan. Coronary angiography was unremarkable. Neither perihilar nor mediastinal lymphadenopathy was noted. The patient also suffered three times from tonic-clonic generalized seizures in 3 years, but no neurologic abnormalities were detected. The explanted heart displayed multiple white patches on the endomyocardial surface, measuring up to 8x7 cm. On microscopic examination, the lesion consisted of multiple well-formed and confluent granulomas with numerous scattered multinucleated giant cells, CD68-positive epithelioid histiocytes, and T-lymphocytes. Neither microorganisms nor foreign material was identified on special stain and culture study. It has been six months since the heart transplant, and the patient has been doing well.
Bundle-Branch Block ; Chest Pain ; Coronary Angiography ; Electrocardiography ; Giant Cells ; Granuloma ; Heart ; Heart Transplantation* ; Histiocytes ; Humans ; Lymphatic Diseases ; Male ; Middle Aged ; Mortality ; Perfusion ; Sarcoidosis* ; Seizures ; Syncope ; T-Lymphocytes ; Tachycardia, Ventricular ; Thallium

Intestinal capillariasis is caused by a small trichurid nematode, Capillaria philippinensis, which infects freshwater fish as intermediate hosts and subsequently fish eating birds as definitive hosts. It has occurred in areas such as the Philippines and Thailand where people eat raw fish. We report an imported case of intestinal capillariasis in a 31-year-old Korean man who lived in Saipan for ten years. He suffered from diarrhea with weight loss, abdominal distension, and pitting edema in the lower extremities for two years. He ate raw freshwater fish in the Saipan 2 years ago. The diagnosis was confirmed by jejunal biopsy. Flat mucosal surface without villi contained sections of numerous round worms with stichosome, larvae, and eggs which were identified as Capillaria philippinensis. The patient was successfully treated with albendazole.
Adult ; Albendazole ; Biopsy ; Birds ; Capillaria ; Diagnosis ; Diarrhea ; Eating ; Edema ; Eggs ; Fresh Water ; Humans ; Larva ; Lower Extremity ; Ovum ; Philippines ; Protein-Losing Enteropathies* ; Thailand ; Weight Loss

Coccidioidomycosis is an endemic disease found in the southwestern part of North America. Travellers who visit the endemic area may carry the infection. We report a case of pulmonary coccidioidomycosis in a 74-year-old woman. She was healthy before visiting Arizona, U.S.A twice. After returning home, she began to complain of intermittent dry coughing. The symptom was mild, however, and she was treated symptomatically. Later a chest radiograph, which was taken 4 years after the onset of the symptom, showed a solitary pulmonary nodule in the right upper lobe. By percutaneous needle aspiration, a few clusters of atypical cells were noted in the necrotic background. A right upper and middle lobectomy was done. A 1.5 x 1.5 x 1.2 cm sized tan nodule was present in otherwise normal lung parenchyma. Microscopically, the nodule consisted of aggregates of multiple solid granulomas inside of which was mostly necrotic. Neutrophils and nuclear debris were scattered along the periphery of the necrotic foci. Numerous multinucleated giant cells were associated with the granulomas. In the necrotic area, mature spherules of Coccidioides immitis, which were 30-100 microm in diameter, were present. They contained numerous endospores which ranged from 5 to 15 microm and were also noted in multinucleated giant cells. The diagnosis of coccidioidomycosis was made. She is doing well after the resection.
Aged ; Case Report ; Coccidioides* ; Coccidioidomycosis/pathology ; Coccidioidomycosis/microbiology* ; Female ; Human ; Korea ; Lung Diseases, Fungal/pathology ; Lung Diseases, Fungal/microbiology*