Purpose: To investigate urine microbiome differences among healthy women, women with recurrent uncomplicated cystitis (rUC), and those with sporadic/single uncomplicated cystitis (sUC) to challenge traditional beliefs about origins of these infections. Materials and Methods: Patients who underwent both conventional urine culture and next-generation sequencing (NGS) of urine were retrospectively reviewed. Symptom-free women with normal urinalysis results as a control group were also studied. Samples were collected via transurethral catheterization. Results: In the control group, urine microbiome was detected on NGS in 83.3%, with Lactobacillus and Prevotella being the most abundant genera. The sensitivity of urine NGS was significantly higher than that of conventional urine culture in both the sUC group (91.2% vs. 32.4%) and the rUC group (82.4% vs. 16.4%). In urine NGS results, Enterobacterales, Prevotella, and Escherichia/ Shigella were additionally found in the sUC group, while the recurrent urinary tract infection (rUTI)/rUC group exhibited the presence of Lactobacillus, Prevotella, Enterobacterales, Escherichia/Shigella, and Propionibacterium. Moreover, distinct patterns of urine NGS were observed based on menopausal status and ingestion of antibiotics or probiotics prior to NGS test sampling. Conclusions Urine microbiomes in control, sUC, and rUTI/rUC groups exhibited distinct characteristics. Notably, sUC and rUC might represent entirely separate pathological processes, given their distinct urine microbiomes. Consequently, the use of urine NGS might be essential to enhancing sensitivity compared to conventional urine culture in both sUC and rUTI/rUC groups.

PURPOSE: Nutritional therapy (NT), such as enteral nutrition (EN) or parenteral nutrition (PN), is essential for the malnourished patients. Although the complications related to NT has been well described, multicenter data on symptoms in the patients with receiving NT during hospitalization are still lacking. METHODS: Nutrition support team (NST) consultations, on which NT-related complications were described, were collected retrospectively for one year. The inclusion criteria were patients who were (1) older than 18 years, (2) hospitalized, and (3) receiving EN or PN at the time of NST consultation. The patients' demographics (age, sex, body mass index [BMI]), type of NT and type of complication were collected. To compare the severity of each complication, the intensive care unit (ICU) admission, hospital stay, and type of discharge were also collected. RESULTS: A total of 14,600 NT-related complications were collected from 13,418 cases from 27 hospitals in Korea. The mean age and BMI were 65.4 years and 21.8 kg/m2. The complications according to the type of NT, calorie deficiency (32.4%, n=1,229) and diarrhea (21.6%, n=820) were most common in EN. Similarly, calorie deficiency (56.8%, n=4,030) and GI problem except for diarrhea (8.6%, n=611) were most common in PN. Regarding the clinical outcomes, 18.7% (n=2,158) finally expired, 58.1% (n=7,027) were admitted to ICU, and the mean hospital days after NT-related complication were 31.3 days. Volume overload (odds ratio [OR]=3.48) and renal abnormality (OR=2.50) were closely associated with hospital death; hyperammonemia (OR=3.09) and renal abnormality (OR=2.77) were associated with ICU admission; “micronutrient and vitamin deficiency” (geometric mean [GM]=2.23) and volume overload (GM=1.61) were associated with a longer hospital stay. CONCLUSION: NT may induce or be associated with several complications, and some of them may seriously affect the patient's outcome. NST personnel in each hospital should be aware of each problem during nutritional support.
Adult ; Body Mass Index ; Demography ; Diarrhea ; Enteral Nutrition ; Hospitalization ; Humans ; Hyperammonemia ; Intensive Care Units ; Korea ; Length of Stay ; Multicenter Studies as Topic ; Nutrition Therapy ; Nutritional Support ; Parenteral Nutrition ; Referral and Consultation ; Retrospective Studies ; Vitamins

Gastric remnant necrosis after a subtotal gastrectomy is an extremely uncommon complication due to the rich vascular supply of the stomach. Despite its rareness, it must be carefully addressed considering the significant mortality rate associated with this condition. Patients vulnerable to ischemic vascular disease in particular need closer attention and should be treated more cautiously. When gastric remnant necrosis is suspected, an urgent endoscopic examination must be performed. We report a case of gastric remnant necrosis following a subtotal gastrectomy and discuss possible risk factors associated with this complication.
Endoscopy ; Gastrectomy* ; Gastric Stump* ; Humans ; Ischemia ; Mortality ; Necrosis* ; Risk Factors ; Splenic Infarction* ; Stomach ; Vascular Diseases

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion. METHODS: The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR). RESULTS: The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70). CONCLUSIONS: The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.
APACHE* ; Calibration ; Cohort Studies ; Comorbidity ; Critical Care ; Discrimination (Psychology) ; Hospital Mortality ; Intensive Care Units ; Korea ; Mortality* ; Prospective Studies ; Respiratory Distress Syndrome, Adult ; Risk Factors ; ROC Curve ; Tertiary Care Centers* ; Triage

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion. METHODS: The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR). RESULTS: The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70). CONCLUSIONS: The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.
APACHE ; Calibration ; Cohort Studies ; Comorbidity ; Critical Care ; Discrimination (Psychology) ; Hospital Mortality ; Intensive Care Units ; Korea ; Mortality ; Prospective Studies ; Respiratory Distress Syndrome, Adult ; Risk Factors ; ROC Curve ; Tertiary Care Centers ; Triage

BACKGROUND/AIMS: In gastric cancer, the rate of recurrence and metastasis following radical resection is high, necessitating improvement in survival and cure rates. Neoadjuvant chemotherapy (NAC) has potential benefits for locally advanced gastric cancer; however, the surgical benefits and effects on survival are unclear. This study evaluates the effectiveness of NAC in locally advanced gastric cancer and compares clinical outcomes of doublet and triplet regimens. METHODS: We reviewed patient medical records of 383 patients who underwent NAC (n=41) or surgery only (n=342) for treatment of locally advanced gastric cancer. The baseline characteristics and clinical outcomes were compared between the groups. Chemotherapy patients were classified according to regimen, doublet (n=28) and triplet (n=13), and NAC-related clinical response, safety, and toxicity were analyzed. RESULTS: The baseline characteristics did not differ significantly between groups. After NAC, the tumor downstage rate was 51.2% (21/41); however, overall survival (p=0.205) and disease-free survival (p=0.415) were not significantly different between the groups. On subgroup analysis, no significant differences in drug toxicity (p=0.604) or clinical response (p=0.374) were found between outcomes of doublet and triplet chemotherapy regimens. CONCLUSIONS: In patients with locally advanced gastric cancer, NAC showed tolerable drug toxicity and increased tumor downstage, but NAC failed to increase the survival rate, which may be caused by a high D2-lymphadenectomy rate. Therefore, NAC was found to be a therapeutic option for select gastric cancer patients.
Adenocarcinoma ; Disease-Free Survival ; Drug Therapy* ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Medical Records ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Recurrence ; Stomach ; Stomach Neoplasms* ; Survival Rate ; Triplets*

PURPOSE: We report a case of a patient with ptosis, lid swelling, limitation of ocular movement, and visual disturbance after a trauma. The patient was diagnosed with unilateral orbital cellulitis, ophthalmic vein thrombosis and bilateral septic cavernous thrombosis and treated. CASE SUMMARY: After head and facial area trauma that occurred 1 month earlier, a 56-year-old man suffered from ongoing visual loss, limitation of ocular movement in all directions, proptosis in the left eye and abduction limitation of the right eye. A week before admission, mild fever and chills were also present. At admission, visual acuity of the left eye was no light perception and pupil reflex was lost. Brain MRA and MRI indicated dilation and thrombosis of the left superior ophthalmic vein, left orbital cellulitis and inflammation in bilateral cavernous sinuses. The patient was immediately treated with systemic antibiotics and steroid injection. Coagulase negative staphylococci were detected in blood culture. CONCLUSIONS: Infection caused by facial trauma spread through the facial area's venous plexus and caused orbital cellulitis. As a result, septic cavernous sinus thrombosis and ophthalmic vein thrombophlebitis occurred. Serious complications can occur after facial trauma, thus rapid differential diagnosis and appropriate treatment are important in determining prognosis.
Anti-Bacterial Agents ; Brain ; Cavernous Sinus ; Cavernous Sinus Thrombosis ; Caves ; Chills ; Coagulase ; Diagnosis, Differential ; Exophthalmos ; Eye ; Fever ; Head ; Humans ; Inflammation ; Light ; Orbital Cellulitis ; Prognosis ; Pupil ; Reflex ; Thrombophlebitis ; Thrombosis ; Veins ; Visual Acuity

Trauma is frequently not purely penetrating or purely blunt. Such mixed trauma can result from the mechanism of injury. Recently, we encountered a patient who accidentally shot himself with a shotgun. He had a 15 x 8-cm-sized penetrating injury on left flank that did not penetrate into the peritoneal cavity and a blunt splenic injury with hemoperitoneum. Surgical and interventional treatments were performed for each injury. We present this case with a review of the related literature.
Hemoperitoneum ; Humans ; Peritoneal Cavity

OBJECTIVE: Pituitary apoplexy is one of the most serious life-threatening complications of pituitary adenoma. The purpose of this study is to investigate the visual outcome after early transsphenoidal surgery for the patients with pituitary apoplexy. METHODS: We retrospectively reviewed the 31 patients with pituitary apoplexy who were admitted due to acute visual acuity or field impairment and treated by transsphenoidal surgery. Five patients were excluded because of the decreased conscious level. The visual acuity of each individual eye was evaluated by Snellen's chart. Visual fields were also checked using automated perimetry. To compare the visual outcome according to the surgical timing, we divided the patients into 2 groups. The first group, 21 of the patients have been undertaken transsphenoidal approach (TSA) within at least 48 hours after admission. The second group included 8 patients who have been undertaken TSA beyond 48 hours. All patients were monitored at least 12 months after surgery. RESULTS: Patients were 21 males and 8 females (M : F=2.6 : 1) with the mean age of 42.4 years. Among the enrolled 29 patients, 26 patients presented with decreased visual acuity and 23 patients revealed the defective visual field respectively. Postoperatively, improvement in the visual acuity was seen in 15 patients (83.3%) who underwent surgery within the first 48 hours of presentation, as compared to those in whom surgery was delayed beyond 48 hours (n=5; 62.5%) (p=0.014). Improvement in the visual field deficits was observed in 15 (88.2%) of patients who had been operated on within the first 48 hours of presentation, as compared to those in whom surgery was delayed beyond 48 hours (n=3; 50.0%) (p=0.037). CONCLUSION: This study suggests that rapid transsphenoidal surgery is effective to recover the visual impairment in patients with pituitary apoplexy. If there are associated abnormalities of visual acuity or visual fields in patients with hemorrhagic pituitary apoplexy, early neurosurgical intervention within 48 hours should be also required to recover visual impairment.
Eye ; Female ; Humans ; Male ; Pituitary Apoplexy ; Pituitary Neoplasms ; Retrospective Studies ; Vision Disorders ; Vision, Ocular ; Visual Acuity ; Visual Field Tests ; Visual Fields

OBJECTIVE: Minocycline, a second-generation tetracycline-class antibiotic, has been well established to exert a neuroprotective effect in animal models and neurodegenerative disease through the inhibition of microglia. Here, we investigated the effects of minocycline on motor recovery and neuropathic pain in a rat model of spinal cord injury. METHODS: To simulate spinal cord injury, the rats' spinal cords were hemisected at the 10th thoracic level (T10). Minocycline was injected intraperitoneally, and was administered 30 minutes prior surgery and every second postoperative day until sacrifice 28 days after surgery. Motor recovery was assessed via the Basso-Beattie-Bresnahan test. Mechanical hyperalgesia was measured throughout the 28-day post-operative course via the von Frey test. Microglial and astrocyte activation was assessed by immunohistochemical staining for ionized calcium binding adaptor molecule 1 (Iba1) and glial fibrillary acidic protein (GFAP) at two sites: at the level of hemisection and at the 5th lumbar level (L5). RESULTS: In rats, spinal cord hemisection reduced locomotor function and induced a mechanical hyperalgesia of the ipsilateral hind limb. The expression of Iba1 and GFAP was also increased in the dorsal and ventral horns of the spinal cord at the site of hemisection and at the L5 level. Intraperitoneal injection of minocycline facilitated overall motor recovery and attenuated mechanical hyperalgesia. The expression of Iba1 and GFAP in the spinal cord was also reduced in rats treated with minocycline. CONCLUSION: By inhibiting microglia and astrocyte activation, minocycline may facilitate motor recovery and attenuate mechanical hyperalgesia in individuals with spinal cord injuries.
Animals ; Astrocytes ; Calcium ; Extremities ; Glial Fibrillary Acidic Protein ; Horns ; Hyperalgesia ; Injections, Intraperitoneal ; Microglia ; Minocycline ; Models, Animal ; Motor Neurons ; Neuralgia ; Neurodegenerative Diseases ; Neuroprotective Agents ; Rats ; Spinal Cord ; Spinal Cord Injuries